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THE PSYCHOANALYTIC THEORY OF NEUROSIS 

havior, which initiated the changes, was psychogenic; the attitude was intended 
to relieve the internal pressure; the somatic symptom, which was the consequence 
of the attitude, was not sought by the person, either consciously or unconsciously. 

HORMONAL AND VEGETATIVE DYSFUNCTIONS 

The three categories of organ-neurotic symptoms, affect equivalents, physical 
expressions of a disturbed chemistry, and physical expressions of unconscious 
attitudes, appear usually in a combined form. Often the symptoms remain 
limited to a given organ or system of organs, the choice depending primarily on 
physical and constitutional factors but also on all the other factors that like- 
wise determine the “somatic compliance” in conversion symptoms (see pp. 227 f .) . 
The hormonal-vegetative system, however, cannot be simply classified as one 
of the various organ systems, such as the intestinal, respiratory, or circulatory 
system. Rather, the greater part of the functional disturbances in these systems 
is created through hormonal-vegetative pathways, the symptoms “due to the 
distorted chemistry of the unsatisfied person” being exclusively determined in 
this way. Thus when introducing the heading “Hormonal and Vegetative 
Dysfunctions” before discussing the various organ systems, we only intend to 
discuss the influence of unconscious attitudes on hormones and to clarify a few 
points that occasionally arc confused. 

Attitudes caused by unconscious instinctual conflicts may, of course, influence 
the hormonal functions and thus produce secondary somatic symptoms not 
intended as such. The same kind of influence that an unconscious desire has on 
the production of the gastric juice in cases of peptic ulcer (see p. 245), other 
desires have on the production of hormones regulating metabolism (ef. 189), 
for instance a psychogenic identification with the opposite sex. 

There is no doubt that in menstrual or premenstrual mental disorders in 
women, a somatic factor always plays a part, namely, the physical alterations at 
the source of the instinctual drives. But on the other hand the unconscious sig- 
nificance of the idea of menstruation and the mental reaction to this significance 
may likewise alter the hormonal events. In cases of disturbances, the pre- 
menstrual body feeling represents tension, retention (sometimes pregnancy), 
dirt, pregcnitality, hatred; the menstrual flow may bring relaxation, and is felt as 
evacuation (sometimes birth), cleanliness, genitality, love; but it may also repre- 
sent loss of anal and urethral control, Oedipus guilt, castration, the frustration of 
wishes for a child, and humiliation. 

Every pregenital fixation necessarily changes the hormonal status. However, 
not all orally fixated patients become either obese or extremely thin. Probably 
. this happens if an oral fixation coincides with a certain hormonal constitution. 
Many cases of obesity anfl extreme thinness belong in this category. 



ORGAN NEUROSES 


241 


Hilde Bruch who has had a great and extraordinary experience with obese 
children (209, 21 1), states that the majority of cases do not seem to be primarily 
hormonal in nature but rather psychogenic, that is, brought about by an incor- 
rect economics of energy, by too much food supply and too little motor discharge. 
Psychoanalytically, this mistake in economy is due to primary psychogenic con- 
flicts or developmental disturbances. “Obesity in childhood represents a dis- 
turbance in personality in which excessive bodily size becomes the expressive 
organ of a conflict” (210). 

Wulff has described a psychoneurosis, not infrequent in women, which Is 
related to hysteria, cyclothymia and addiction (1619). This neurosis is char- 
acterized by the person’s fight against her sexuality which, through previous 
repression, has become especially greedy and insatiable. This sexuality is pre- 
genitally oriented, and sexual satisfaction is perceived of as a “dirty meal ” Pe- 
riods of depression in which the patients stuff themselves (or drink) and feel 
themselves “fat,” “bloated,” “dirty,” “untidy,” or “pregnant” and leave their 
surroundings untidy, too, alternate with “good” periods in which they behave 
ascetically, feel slim, and conduct themselves either normally or with some ela- 
tion. The body feeling in the “fat” periods turns out to be a repetition of the 
way the girl felt at puberty before her first menstruation, and the spells often 
actually coincide with the premenstrual period. The menstrual flow then usually 
brings a feeling of relief: “The fat-making dirt is pouring out; now I am slim 
again, and will be a good girl and not eat too much.” The alternating feelings of 
ugliness and beauty connected with these periods show that exhibitionistic con- 
flicts also are of basic importance in this syndrome. Psychoanalysis discloses that 
the unconscious content of this syndrome is a preoedipal mother conflict, which 
may be covered by an oral-sadistic Oedipus complex. The patients have an intense 
unconscious hatred against their mothers and against femininity. To them being 
fat means getting breasts, being uncontrolled, incontinent or even pregnant. The 
urge to eat has the unconscious aim of incorporating something that may relax 
the disagreeable inner “feminine” tension, eating meaning rcincorporation of an 
object, whose loss has caused the patient to feel hungry, constipated, castrated, 
feminine, fat; that is, the food means milk, penis, child, and narcissistic supplies 
which soothe anxieties. The exhibitionistic behavior signifies a tendency to compel 
the receipt of these supplies and the fear of not getting them because of repulsive 
ugliness. The depression signifies the recurrent failure of the tendency to regain 
the lost stability, a failure that occurs because of the forbidden oral-sadistic means 
by which this re-establishment is attempted. The ascetic periods, by pacifying the 
superego, achieve a greater degree of relaxation. 

In some cases this neurosis is nothing but a kind of food addiction, and shotiki 
rather be discussed in the chapter on addictions (see p. 381). In other cases, havif 
ever, not only body feelings but actual body changes dominate the pifturc. C 3 ar- 




THE PSYCHOANALYTIC THEORY OF NEUROSIS 




THE 

PSYCHOANALYTIC THEORY 
OF NEUROSIS 


By OTTO FENICHEL, M.D. 


KEGAN PAUL, TRENCH, TRUBNER 6- CO. Ltd 
Broadway House, 68-74 Carter Lane, London, E.C. ^ 





First publisliecl in Oj'cxit Hrititin *94^ 


3PW»OBdl in tiie U,S.Af 



PREFACE 


Nearly twenty years of teaching at different psychoanalytic institutes and tiain- 
ing centers both in Europe and in America — as staff member in five cities and 
as occasional guest lecturer in ten others — have convinced me of the need to sum- 
marize the psychoanalytic doctrines in a systematic and comprehensive manner, 
and thus to provide teaching aids for psychoanalytic training. 

Among the different disciplines a textbook of psychoanalysis should embrace, 
the theory of neurosis interested me in particular* At European psychoanalytic 
institutes the custom was to subdivide this field into a general part, treating the 
mechanisms common to all neuroses, and a special part, treating the chaiacter- 
istic features of the individual neuroses. Because chance first brought me to the 
special part, I published in 1932 Spezielle Psychoanalytische Neurosenlehre at 
the Internationaler Psychoanalytischer Verlag in Vienna, Austria* llhis book 
was translated by Dr. Bertram D. Lewin and Dr. Gregory Zilboorg, and pub- 
lished in 1934 in the Psychoanalytic Quarterly and, as a book, by W* W* Norton 
and Company, New York, under the title Outline of Clinical Psychoanalysis 
(424). 

The lack of a '‘General Part” was the main drawback of this book* Therefore, 
when I was asked to prepare a second edition, I preferred to, write a new book, 
which would not only treat the subject matter of the Outline in a more systema- 
tized and up-to-date form, but the questions of “general” theory as well 

Among the many acknowledgments I wish to make, I want to exprejss my 
gratitude first of all to the listeners of the various coprses from which the follow- 
ing pages have been derived. Their suggestions and remarks during the discus- 
sion proved to be very helpful For advice concerning the final English formula- 
tion, I am especially obliged to Drs, David Brunswick, Ralph Greenson, and 
Norman Reider, and to Mmes. Dorothy Dcinum and Ruth Lachenbruch* 


Otto Fen.ichei, 




CONTENTS 


PREFACE 


V 


PAKT ONE 

PRELIMINARY CONSIDERATIONS 
A. Introduction 

I. INTRODUCTORY REMARKS ON PSYCHOANALYSIS AND 

THE THEORY OF NEUROSIS 3 

II. THE DYNAMIC, THE ECONOMIC, AND THE STRUCTURAL 

POINTS OF VIEW 11 

Mental Dynamics ■ Mental Economics • Conscious and Unconscious 

• The Mental Structure • Initial Essay at a Definition of Neurosis • 
Neurotic Symptoms and AHects 

III. THE METHOD OF PSYCHOANALYSIS 23 

Introductory Remarks • The Basic Rule • Interpretation • Devices of 
Distortion • Types of Resistances • Transference • Criteria for the 
Correctness of Interpretations 

B. The Mental Development 

I IV. EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 33 

Methodological Difficulties in the Investigation of the< Early Phases of 
Development • The Earliest Stages * The Finding of Objects and the 
Constitution of the Ego • Early Perception and Primary Identification 

* Omnipotence and Self-Esteem * The Development of Motility and 
Active Mastery • Anxiety * Thinking and the Development of the 
Sense of Reality • Defenses against Impulses • Further Remarks about 
Adaptation and Reality Sense 

\ V. EARLY MENTAL DEVELOPMENT (CONTINUED): DEVEL- 
OPMENT OF INSTINCTS, INFANTILE SEXUALITY 54 

What Are Instincts? • Classification of Instincts - Criticisms of the 
Concept of a Death Instinct • Infantile Sexuality * The Oral Stage ' 

The Anal-Sadistic Stage * Urethral Eroticism * Other Erogenous 
Zones ’ Partial Instincts • The fhallic Phase; Castration Anxiety in 
Boys * The Phallic Phase in Girls; Penis Envy • The Archaic Types 
of Object Relationships • Love and Hate * Social Feelings • The 
Mother as the First Object * Change of Object in Girls • The Oedipus 
Complex • Types of Object Choice - The Problem of Female Castra- 
tion Fear • Summary 

j VL LATER PHASES OF DEVELOPMENT: THE SUPEREGO ' 102 
Early Stages of the Superego * The Establishment of the Superego ‘ 

The Functions of the Superego • The ‘'Passing of the Oedipus Com- 
plex” • Vicissitudes of the Superego • The Latency Period • Puberty 
i vii 



Vlll 


CONTENTS 


PART TWO 

PSYCHOANALYTIC THEORY OF NEUROSIS 

A. Traumatic Neuroses 

Ivir. TRAUMATIC NEUROSES 117 

The Concept of Trauma • Blocking of or Decrease in Ego Functions 
• Emotional Spells • Sleep Disturbances anti Repetition Symptoms • 
Psychoneurotic Complications • Secondary Gains ■ Psychoanalysis in 
the Therapy of Traumatic Neuroses 


B. Psychoneuroses, the Neurotic Conflict 

VIII. THE MOTIVES OF DEFENSE < 129 

^ What Is a Neurotic Conflict? • Are Neurotic Conflicts between Op- 
posing Instincts Possible? • The External World in Neurotic Conflicts 
■ The Superego in Neurotic Conflicts • Anxiety as Motive for De- 
fense ■ Guilt Feelings as Motive for Defense * Disgust and Shame as 
Motives for Defense * Summary * Are There Any Innate Primary 
Anti-Instinct Forces? 

IX THE MECHANISMS OF DEFENSE 141 

Classification of Defenses • Sublimation • Pathogenic Defenses * De- 
fenses against Affects 

X THE DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC 

CONFLICT 168 

Classification of the Direct Clinical Symptoms of the Neurotic Conflict 
• Specific Avoidances and Inhibitions ■ Impotence and Frigidity * 
Inhibitions of Partial Instincts ■ Inhibitions of Aggressiveness * In- 
hibitions of Sexual ized Functions • Actual Neuroses, Symptoms of 
Unspecific Inhibitions • Anxiety Neurosis * Positive Neurasthenic 
Symptoms • Distu rbances of Sleep • General Remarks about Chronic 
Neurasthenia * Therapeutic Psychoanalysis in Actual Neuroses 

C. Psychoneuroses. Mechanisms of Symptom Formation, 
and Special Neuroses 

XL / ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTERIA 193 
The Nature of the Psychoneurotic Symptom • Anxiety in Anxiety 
Hysteria • The Displacement in Anxiety Hysteria * Projection of 
One's Own Excitement in Anxiety Hysteria ■ Anxiety Hysteria and 
Animism ■ Regression and Aggressiveness in Anxiety Hysteria • Fur- 
ther Development of Anxiety Hysterias • The Repressing Forces and 
the Repressed in the Symptoms of Anxiety Hysteria -^Anjgiety Hys- 
teria in Small Children - The Primal Scene * Therapeutic Psycho- 
' analysis in Anxiety Hysteria 

XII. CONVERSION ^ 216 

What Is Conversion? • Prerequisites for the Development of Con- 
versions Hysterical Spells • Monosymptomatic Conversions • Hys- 
terical Pains and Hysterical Identification • Hysterical Hallucinations 



CONTENTS 


IX 


■ Hysterical Motor Disturbances • Hysterica^ Dream States and Dis- 
turbances of Consciousness • Hysterical Disturbances of the Special 
Senses • Hysterical Disturbances of Sensation • Somatic Compliance 

• Archaic Features in Conversion * General Significance of Conver- 
sion • Oedipus Complex, Masturbation, and Pregenitality in Con- 
version Symptoms ■ Course and Psychoanalytic Treatment of Conver- 
sion Hysteria 

Xril. ORGAN NEUROSES 236 

What Is an Organ-Neurotic Symptom? • Affect Equivalents • The 
Disturbed Chemistry of the Unsatisfied Person * Physical Results of 
Unconscious Attitudes ■ Hormonal and Vegetative Dysfunctions ' 
Digression on Hyper- and Hyposexuality • Gastrointestinal Tract 

• Muscular System * Respiratory System * Heart and Circulatory 
System • Blood Pressure • Skin • Eye * Problems of the Psycho- 
genesis of Organic Diseases and of Pathoneuroses * Hypochondriasis 

• Psychoanalytic Therapy in Organ Neuroses • Appendix: Epilepsy 

xrv. OBSESSION AND COMPULSION 268 

The Phenomenon of Compulsion • Instinct and Defense in Compul- 
sion Symptoms • Regression in Compulsion Neurosis • Digression 
about the Anal Character • Compulsive Systems * Other Defense 
Mechanisms in Compulsion Neurosis • The Double Front of the Ego 
in Compulsion Neurosis * Thinking in Compulsion Neurosis * Magic 
and Superstition in Compulsion Neurosis • The Physical Attitude of 
Compulsion Neurotics * The Problem of Differential Etiology • 
Course and Summary • Therapeutic Psychoanalysis in Compulsion 
Neurosis 

. XV. PREGENITAL CONVERSIONS 311 

General Remarks about Prcgenital Conversions • Stuttering ■ Psy- 
chogenic Tic • Bronchial Asthma 

XVI. PERVERSIONS AND IMPULSE NEUROSES * 324 

General Remarks ’ Perversions in General - Male Homosexuality 

• Female Homosexuality * Fetishism • Trans vestitism • Exhibition- 
ism * Voyeurism * Braid Cutting * Coprophilia • Oral Perversions * 
Extreme Sexual Submissiveness * Sadism ■ Masochism • Combina- 
tions of Perversions with Neuroses and the Differential Etiology of 
Perversions • Psychoanalytic Therapy of Perversions • Impulse 
Neuroses in General * Impulsive Running Away • Cleptomania • 
Pyromania * Gambling • Instinct-Ridden Characters * Drug Addic- 
tion • Addictions without Drugs • Transitional States between Mor- 
bid Impulses and Compulsions * Psychoanalytic Therapy in Impulse 
Neuroses and Addictions 

XVIL DEPRESSION AND MANIA 387 

Depression and Self-Esteem * Orality in Depression ■ Outline of the 
Problems in the Mechanisms of Depression ■ Mourning and Depres- 
sion * The Pathognomonic Introjection ■ The Conflict between the 
Superego and the Ego • Suicide • The Decisive Regression and Its 
Causes • Mania * Historical Summary * Therapeutic Psychoanalysis 
^ in Manic-Depressive Disorders * 

XVinySCHIZOPHRENIA _ 415 

Introductory Remarks * Symptoms of Regression in Schizophrenia * 



X 


CONTENTS 


Restitutional Symptoms in Schizophrenia ■ The Break with Reality 
• Borderline Cases ■ Question of Prognosis • Therapeutic Psycho- 
analysis in Schizophrenia 


D. Psychoneuroses, the Secondary Elaborations of Symptoms 

' XIX. DEFENSES AGAINST SYMPTOMS, AND SECONDARY GAINS 453 
General Remarks ■ Symptoms as Traumata, and Precipitating Fac- 
tors in Neuroses • Defenses against Symptoms ■ Oral -Dependent At- 
titudes toward Symptoms • Mastering of Symptoms ■ Secondary 
Gains from Illness 

XX. CHARACTER DISORDERS 453 

Bases for the Development of Psychoanalytic Characterology ■ Intro- 
ductory Remarks on Pathological Character Traits • What Is “Char- 
acter”? • Classification of Character Traits ■ The Sublimation Type 
of Character Traits • The Reactive Type of Character Trails • De- 
fense and Instinctual Impulse in Pathological Character Traits • Path- 
ologial Behavior toward the Id • Pathological Behavior toward' the 
Superego • Pathological Behavior toward External Objects • Patho- 
logical Interrelationships of the Ego’s Dependencies ■ The DifTercntial 
Etiology of Various Characters and Types of Defense • Tyjrology • 
Ehobic and Hysterical Characters • Compulsive Characters • Cyclic 
Characters • Schizoid Characters ■ Digression: Two Short Case His- 
tories • Psychoanalytic Technique and Therapy in Character Disorders 

E. Combinations of Traumatic Neuroses and Psychoneuroses 

XXL COMBINATIONS OF TRAUMATIC NEUROSES AND PSYCHO- 
NEUROSES cdi 


F. Course and Therapy of Neuroses 

XXII. THE CLINICAL COURSE OF NEUROSES 547 

Spontaneous Cures ■ Stationary Neuroses * Progredient Neuroses 

XXIII, THERAPY AND PROPHYLAXIS OF NEUROSES 554 

Psychotherapy • Shock Therapy • Psychoanalysis as a Therapeutic 
Meth^ > Indications for Psychoanalytic Treatment ■ Contraindica- 
Uons for Psychoanalytic Treatment • About Statistics on Therapeutic 
Results of Psychoanalysis • Prophylaxis 

bibliography 55JJ 

INDEX 



PART I 

PRELIMINARY CONSIDERATIONS 




A. Introduction 

CHAPTERS I“III 


Chapter I 

INTRODUCTORY REMARKS ON PSYCHOANALYSIS 
AND THE THEORY OF NEUROSIS 


Concerning the origin of the young science of psychoanalysis one often hears two 
diametrically opposed opinions. Some people say t)iat Freud transferred the 
principles of the materialistic biology of his time to the field of mental phe- 
nomena^ and sometimes they even add that Freud therefore, through being 
limited to biology, failed to see the cultural and social determinants of mental 
phenomena. Others state that at a period when the natural sciences were, at their 
height, Freud’s contribution consisted in turning against the spirit of the times 
and forcing the recognition of the irrational and the psychogenic in defiance of 
the prevalent overestimation of rationalism. 

What should we think of this contradiction? Through gradual development, 
scientific thinking is winning out over magical thinking. The natural sciences, 
originating and evolving at definite periods in the development of human society 
(when they had become a technical necessity), have had to overcome the most 
violent and stubborn resistances in their attempt to describe and explain actual 
phenomena. This resistance affected different fields to a different degree. It in- 
creased in proportion to the approach of the subject matter of the science to the 
personal concern of man: physics and chemistry freed themselves earlier than 
biology, biology earlier than anatomy and physiology (not so long ago, the 
pathologist was forbidden to dissect the human body), anatomy and physiology 
earlier than psychology. The influence of magic is greater in medicine than in 
pure natural science, due to the tradition of medicine, which stems from the 
activities of the medicine men and priests. Within medicine, psychiatry is not only 
the youngest branch of this magic-imbued science but it is also the one most 
tainted with magic. 

For centuries psychology was considered a special field of speculative philoso- 
phy, far removed from sober empiricism. If one considers the more or less meta- 
physical questions that used to be of paramount importance, it is easily recog- 
nized that the problems discussed continued to reflect the antithesis of “body 




4 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


and soul,” “human and divine,” “natural and supernatural.” Everywhere valua- 
tions influenced, unfortunately, the examination of facts. 

A glance at the history of science teaches that the process of overcoming magic 
has not been a continuous one. There have been advances and retreats which 
certainly cannot be explained merely in terms of a history of ideas. The fluctua- 
tions in this struggle are dependent on complicated historical conditions. They 
can be understood only through the study of the society in which the struggle 
takes place and of the conflicting interests of its various groups. That the history 
of medical psychology is no exception to this rule can be seen from the inter- 
esting book by Zilboorg and Henry (1636). 

Psychoanalysis represents in this struggle a definite step toward the aim of 
scientific thinking in psychology — away from the magical. Recently Bernfeld 
again stressed the completely materialistic orientation of Freud’s teachers and of 
Freud’s own prepsychoanalytic thinking (140). 

Certainly it must be admitted that Freud was not the first to consider the field 
of mental manifestations from a natural-scientific point of view. There were 
natural-scientific psychologies before him. But conipared to the “philosophical” 
psychologies, these natural-scientific psychologies have always been in the mi- 
nority, and they have only been able to treat disparate mental functions. An 
understanding of the multiplicity of everyday human mental life, based on 
natural science, really began only with psychoanalysis. 

Now the question can be answered concerning the contradictory statements 
of Freud’s place in the history of science. The golden days of materialistic biol- 
ogy and medicine simply did not regard the whole field of humanity as their 
universe of discourse. The neglect of the mental field indicates that the progress 
of scientific thinking was purchased at the price of allowing one entire realm of 
nature, the human mind, to remain a residue of religious and magical thinking; 
and the contradiction in the historic evaluation of Freud’s work is solved by 
recognizing that actually he did both ; by opposing the idea that “mind is brain” 
and by emphasizing strongly the existence of the mental sphere and the inade- 
quacy of physical-scientific methods to deal with it, he won this terrain for 
science. In spite of assertions that Freud by giving the “subjective factor,” the 
“irrational” its just due has turned against rationalism, his procedure clearly 
reveals the spirit of that broad cultural trend which proclaimed as its ideal the 
primacy of reason over magic and the unbiased investigation of reality, What had 
previously been considered sacred and untouchable, now had to be touched, 
because the validity of the taboos was denied. Freud investigated the mental 
world in the same scientific spirit as his teachers had investigated the physical 
world, which implied the same rebellion against the prejudices that had been 
taught up to that time. The subject matter, not the method of psychoanalysis, is 
irrational* 



PSYCHOANALYSIS AND THE THEORY OF NEUROSIS 


5 


The objection may be raised that such a statement is a one-sided presentation 
of psychoanalysis. Does not this science include quite a lot of mystic tradition? 
Did it not deveLp out of hypnotism and the latter from “mesmerism”? Is it not a 
“mental healing,” which means a sort of magic? Certainly psychoanalysis has 
developed directly out of magical therapeutic methods. But it has eliminated 
the magical background of its forerunners. Of course, in every mental develop- 
ment rudiments of earlier phases persist. Actually, it is not difficult to find many 
magical features in the theory and practice of psychoanalysis. (Probably this 
would not be difficult in other branches of medicine either.) Psychoanalysis as it 
is now constituted undoubtedly contains mystic elements, the rudiments of its 
past, as well as natural-scientific elements toward which it is striving. It cannot 
help retaining some mystic elements, at least in the same sense in which the 
activity of a police dog in police investigations is — as Rei k h as recognized (1295) 
— a survival of the animal oracle. However, the police dog has the ability to 
scent out the criminal. It is the aim of psychoanalysis to reduce its magical ele- 
ments at least to the same level of insignificance as that to which modern criminal 
investigation tries to reduce the magical elements in its detective methods. 

Scientific psychology explains mental phenomena as a result of the interplay 
of primitive physical needs — rooted in the biological structure of man and devel- 
oped in the course of biological history (and therefore changeable in the course 
of further biological history)-— and the influences of the environment on these 
needs. There is no place for any third factor. 

That the mind is to be explained in terms of constitution and milieu is a very 
old conception. What is characteristic for psychoanalysis is what it regards as 
biological structure, which environmental influences it recognizes as formative, 
and how it relates structural and environmental influences to each other. 

As to the biological structure, a scientific psychology first of all must posit 
itself within biology. Mental phenomena occur only in living organisms; mental 
phenomena are a special instance of life phenomena. The general laws that arc 
valid for life phenomena are also valid for mental phenomena; special laws that 
are valid only for the level of mental phenomena must be added. 

Thus a scientific psychology investigates, as does any science, general laws. 
It is not satisfied with a mere description of individual psychic processes. An 
exact description of historical processes is its means, not its goal. Its subject is not 
the individual X but the comprehension of general laws governing mental 
functions. 

Besides, a scientific psychology is absolutely free of moral valuation. For it, 
there is no good or evil, no moral or immoral, and no what ought to be at all; 
for a scientific psychology, good and evil, moral and immoral, and what ought to 
be are products of human minds and have to be investigated as such. 

As to the influences of the surroundings, these must be studied in detail in 



6 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


their practical reality. There is no “psychology of man” in a general sense, in a 
vacuum, as it were, but only a psychology of man in a certain concrete society 
and in a certain social place within this concrete society. 

Concerning the relation between biological needs and the formative environ- 
mental influences, this book will demonstrate adequately how psychoanalysis 
approaches the problem. At this point, only the following needs to be said. In the 
endeavor to investigate the relationship between biological needs and external 
influences, one or the other of these two forces may be overestimated. The his- 
tory of psychoanalysis has seen both types of deviation. Certain authors, in their 
biologistic thinking have entirely overlooked the role of outwardly determined 
frustrations in the genesis of neuroses and character traits, and arc of the opinion 
that neuroses and character traits might be rooted in conflicts beiw^ccn contra- 
dictory biological needs in an entirely endogenous manner. Such a point of view 
is dangerous even in therapeutic analysis; but it becomes entirely fatal if it is 
assumed in applications of psychoanalysis to sociological questions. Attempts of 
this kind have sought to understand social institutions as the outcome of con- 
flicts between contradictory instinctual impulses within the same individuals, 
instead of seeking to understand the instinctual structure of empirical human 
beings through the social institutions in which they grew up. 

But there are also certain authors at the other extreme who reproach psycho- 
analysis as being too biologically oriented, and who arc of the opinion that the 
high evaluation of the instinctual impulses means that cultural influences are 
denied or neglected. They are even of the erroneous opinion that the demonstra- 
tion of the importance of cultural influences contradicts any instinct theory. 
Freud’s own writings contain, essentially, descriptions of how instinctual atti- 
tudes, objects, and aims are changed under the influence of experiences. Thus it 
is absurd to be of the opinion that the proof of the existence of this influence 
contradicts Freud. 

* We agree with Zilboorg that it is not difficult to find in all such “culturistic*' 
deviations a distorted return to magical thinking and to the contrast of body and 
soul (1637). At first glance it looks as if the stressing of cultural factors, because 
of their significance for mental development, expressly brought about an em- 
phasis on reality; but actually this viewpoint denies reality by denying man’s 
biological basis. 

Certainly not only frustrations and reactions to frustrations arc socially deter- 
mined; what a human being desires is also determined by his cultural environ- 
ment. However, the culturally determined desires are merely variations of a few 
biological basic needs; changing the primitive biological values of “gratifying” 
and “frustrating” into the highly complicated systems of values of modern man 
is just the thing that can be explained by psychoanalytic study of the history of 
the particular man and the influences of social forces to which he has been 



PSYCHOANALYSIS AND THE THEOEY OF NEUROSIS 7 

subjected. It is the task of sociology to study these social forces, their genesis, and 
their function. 

The application of the general principles of natural science to the special field 
of psychology naturally presupposes the development of new methods of research 
that are adequate to its subject matter. Attempts to keep the mental realm out- 
side of causal and quantitative thinking (“theory grays the many-colored pattern 
of life”) thwart real insight, as does also a pseudo exactness which believes it 
necessary to transfer the biological methods of experiment and scientific pro- 
tocol to a field where these methods* are not suitable. (Astronomy also is unable 
to resort to experiments and nevertheless is a natural science.) 

Against the statement that psychoanalysis aims at the full scientific research 
into mental phenomena, it might be objected that this formulation is either too 
narrow or too broad. Psychoanalysis maintains that there is an unconscious 
mental life, and that it studies this unconscious. Since under the term “the 
human mind” the conscious phenomena are usually understood, it would seem 
that psychoanalysis is concerned with more than just human mental life. On 
the other hand it may be asked: is not psychoanalysis above all a psychology of 
neuroses, or a psychology of instincts, or a psychology of the emotional com- 
ponents in mental life — whereas the more intellectual components and the 
individual functions, such as perception, the formation of conceptions, judgment, 
would have to be investigated by other psychologies.'^ 

These objections are not valid. The thesis that in investigating the uncon- 
scious, psychoanalysis is undertaking something that lies beyond psychic phe- 
nomena may be compared to an assertion that optics is investigating something 
other than the phenomena of light when it occupies itself with the wave lengths 
of light waves. The existence of the unconscious is an assumption that forced 
itself upon psychoanalytic research when it sought a scientific explanation and 
a comprehension of conscious phenomena. Without such an assumption the 
data of the conscious in their interrelationships remain incomprehensible; with 
such an assumption, that which characterizes the success of every science be- 
comes possible: to predict the future and to exert systematic influence. 

As to the argument that psychoanalysis is concerned with neuroses or with 
instinctual and emotional phenomena only, it must be admitted that these sub- 
jects are predominant in psychoanalytic research. This can be explained his- 
torically and practically. Psychoanalysis began as a therapeutic method and even 
today secures its research material principaEy because of the happy circumstance 
that its psychological research method and the medical therapeutic method coin- 
cide. What Freud observed during the treatment of his patients, however, he 
could apply later to an understanding of the mental phenomena of healthy per- , 
sons. When psychoanalysis then went on to study the conscious phenomena 
and the various mental functions, it could do this in a way different from that of 



8 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

Other psychologies, for it had previously studied the unconscious and the in- 
stincts* It conceives of all these “surface manifestations” as structures that have 
been formed out of deeper instinctual and emotional sources through the influ- 
ence of the environment. Of course it should not be claimed that except for the 
Freudian findings there is no scientific psychological knowledge; but it should 
be asserted that all psychological knowledge gains new light when considered 
from the psychoanalytic point of view. 

However, this book is not a textbook of psychoanalytic psychology; it limits 
itself to the theory of neurosis. It is true that neuroses, for the analyst, provide the 
most fruitful study in the realm of mental phenomena; after having studied the 
neuroses, it will be easier to study other mental phenomena. In this sense, this is 
perhaps a first volume of a textbook on psychoanalytic psychology. 

The theory of neurosis has the same relation to psychoanalytic therapeutic 
practice as pathology has to internal medicine: inductively arrived at through 
practical experience, it furnishes the foundation for further practical work. It 
represents an attempt to ascertain that which is regular in the etiology, the 
manifestations, and the clinical course of neuroses, in order to furnish us with a 
causally directed method of therapy and prophylaxis. 

Nothing should be demanded of such a theory that a medical man would not 
demand of pathology. The search for ‘‘regularity” permits a formulation only of 
that which is of general significance and so, in a sense, does violence to the 
uniqueness of the individual case. In compensation, however, it gives the prac- 
titioner a better orientation, even though it must be remembered that this 
orientation alone is not sufficient for the actual treatment of individual cases. 

Wc shall endeavor to clarify the theory by clinical examples. But it will remain 
“theory,” that is, abstraction. All the examples tend only to illustrate mechanisms; 
thus they are illustrations but not case histories. What may be reported in a few 
lines as a result of psychoanalytic research, sometimes required months of work. 

Thus only the typical will be presented here. Actually the psychological facts 
represented by the terms Oedipus complex or castration complex arc infi- 
nitely varied. This book presents the framework which, in clinical reality, 
is filled with thousands of specific facts. Clinical experience with practical 
cases (supervised work with patients and case-history seminars) cannot be 
supplanted by a book like this; neither can it substitute for training in psy- 
choanalytic technique. It can, however, give an impression as to why special 
training in technique is necessary, and why a personal analysis is an irreplaceable 
part of this training. 

Those who have not undergone a personal analysis will probably be able to 
understand intellectually what is presented in this book; but probably many 
things will seem to them even more incredible and “far-fetched” than psycho- 
analytic case reports. Persons who “do not believe in psychoanalysis” will not 



PSYCHOANALYSIS AND THE THEORY OF NEUROSIS 


9 


be convinced by reading this book. They can only inform themselves about 
what the teachings of psychoanalysis actually are. 

But even this seems very necessary. Many critics who *‘do not believe in psy- 
choanalysis” do not know what psychoanalysis is about, and are in the habit of 
ascribing to Freud a great many things he never said or wrote. 

However, the reading of case histories offers the best method for remedying 
deficiencies in personal experience, and is therefore the most important supple- 
ment to the reading of this book, just as attendance at clinical lectures or the 
reading of clinical case reports is the best supplement to the study of pathology. 

It is in no way true that in discussing events of human life one has to choose 
between the vivid, intuitive description of an artist and the detached abstract- 
ness of a scientist thinking only quantitatively. It is not necessary and not per- 
missible to lose feeling when feeling is investigated scientifically. Freud once 
stated that it was not his fault that his case histories gave the impression of a 
novel. To understand neuroses one would have to read such novel-like case his- 
tories as well as books like this; but it can also be promised that such case his- 
tories will be understood in quite another way after this book has been studied. 

The admission that the practical art of analyzing cannot be acquired through 
reading this book is no cause to underestimate its value for the student, of psycho- 
analysis. When objections, such as the claim that the essential therapeutic intui- 
tion and sensitivity cannot be taught, are hurled at a scientific pathology, it is a 
sign of magical thinking. Just as scientific pathology is no barrier to the intuitive 
medical art but an indispensable prerequisite for it, so it is with the theory of 
neurosis and the practice of psychoanalysis. It is true that not everything can be 
taught; but first one has to learn what is teachable. 

We shall try to engage as little as possible in polemics, but concentrate, rather, 
on explaining that which already seems established* It is unavoidable that, in 
the choice of the material to be presented, in the decision as to which problems 
should be given more space and which less, and in the arrangement of the book, 
the personal beliefs of the author are reflected. However, since he hopes that 
his scientific convictions arc well founded, he is of the opinion that this will not 
be a disadvantage. 

In one respect, a theory of neurosis differs from a somatic pathology. A 
pathologist is in a position to assume that his audience knows physiology; he 
docs not have to explain the ‘‘biological basic principles” before he demonstrates 
his real subject matter. Because of the newness of psychoanalytic psychology, 
wc have to clarify first, at least in a sketchy way, the general system by which 
we shall orient ourselves. 

These basic principles were uncovered by the laborious empirical method. It 
is important to emphasize this, because in what follows it cannot be shown how 



10 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


these insights were gradually built up from experience.; they will be presented, 
rather, in a definite, somewhat dogmatic fashion, which might lead to a mis- 
understand iiig of their nature and appear to be purely speculative. Their form 
of presentation will be a deductive one; actually, knowledge of these principles 
has been gained inductively, and further inductive scientific research can and 
may change them. 



Chapter II 

THE DYNAMIC, THE ECONOMIC, AND THE 
STRUCTURAL POINTS OF VIEW 

MENTAL DYNAMICS 

Mental functions should be approached from the same angle as the functions 
of the nervous system in general. They are manifestations of the same basic func- 
tion of the living organism — irritability. The basic pattern which is useful for 
the understanding of mental phenomena is the reflex arc. Stimuli from the out- 
side world or from the body initiate a state of tension that seeks for motor or 
secretory discharge, bringing about relaxation. However, between stimulus and 
discharge, forces are at work opposing the discharge tendency. The study of 
these inhibiting forces, their origin and their effect on the discharge tendency, 
is the immediate subject of psychology. Without these counterforces there would 
be no psyche, only reflex es 

With such a starting point, it is apparent that psychoanalytic psychology at- 
tempts more than mere description. It explains mental phenomena as the result 
of the interaction and counteraction of forces, that is, in a dynamic way. A dy- 
namic explanation is also a genetic one, since it examines not only a phenomenon 
as such but the forces that brought it about as well. It does not examine single 
acts; it examines the phenomena in terms of processes, of development, of pro- 
gression or regression. 

The idea of looking at mental phenomena as a result of interacting forces cer- 
tainly was not derived merely by transferring the concept of energy from the 
other natural sciences to psychology. Originally it happened the other way 
around: the everyday assumption that one understands mental reactions when 
OEte understands their motives has been transferred to physics. 

One special kind of mental phenomena, instinctual drives, is directly experi- 
enced as.an “urging energy.” Certain perceptions have a provocative character: 
they press for immediate action; one feels oneself impelled by forces of various 
intensities. In connecting this experience with the reflex pattern, it may be as- 
sumed that the instinctual impulses have the general tendency to lower the 
excitation level by the discharge of tensions that have been brought about by 
exciting stimuli. Counterforces, to be investigated later, oppose this, and the 
struggle so created constitutes the basis of the realm of mental phenomena. 

This certainly does not mean that psychoanalytic psychology assumes all men- 
tal phenomena to be instinctual in nature. It only means that noninstinctual 
phenomena have to be explained as the effects of external stimuli on biological 
needs. The noninstinctual part of the human mind becomes understandable as 



12 


THE PSYCPIOANALYTIC THEORY OP NEUROSIS 


a derivative of the struggle for and against discharge, created by the influence of 
the external world. Nor does the cell theory nnaintain that all living substance is 
made up only of cells; its position remains justified as long as it succeeds in prov- 
ing that the noncellular components of living substance, like tendons, hair, or 
intercellular material, are parts or products of cells. The same holds true for 
psychoanalytic psychology as long as it can prove that the noninstinctual mental 
phenomena are derivatives of more primitive instinctual ones. Therefore Freud’s 
short paper, “On Negation” (6i6), is of principal importance, for therein he 
shows how the seemingly very remote function of judgment is derived from 
instincts. 

However, the expression T^rieb which Freud uses does not signify exactly the 
same thing as the English expression instinct, as it is cuslomarily translated. In- 
herent in the concept of instinct is the idea that it represents an inherited and 
unchangeable pattern; in the German concept of Trieb this unchangeability is by 
no means implied. On the contrary, the Triehe obviously are changed in aim 
and object under influences stemming from the environment, and Freud was 
even of the opinion that they originated under the same influence (588). This 
incorrect equating of instinct and Trieb has created serious misunderstandings 
(1105). 

The assumption has been made in various forms by many biologists that 
there is a basic vital tendency to abolish tensions that have been brought about 
by external stimulation and to return to the energy state that was effective before 
the stimulation. The most fruitful conception in this respect is Cannon’s formu- 
lation of the principle of “homeostatis” (241). “Organisnis, composed of mate- 
rial which is characterized by the utmost inconstancy and unsteadiness, have 
somehow learned the methods of maintaining constancy and keeping steady in 
the presence of conditions which might reasonably be expected to prove pro- 
foundly disturbing.” The word homeostasis “does not imply something set and 
immobile, a stagnation”; on the contrary, the living functions are extremely 
flexible and mobile, their equilibrium being disturbed uninterruptedly, but being 
re-established by the organism equally uninterruptedly. 

It was the same basic principle Fcchner had in mind when he spoke about the 
“principle of constancy” (605), and for which Freud, following Barbara Low, 
often used the expression “Nirvana principle” (613). It seems more appropriate 
to see the ultimate goal for all these equalization tendencies as the aim of main- 
taining a certain level of tension characteristic for the organism, of “preserving 
the level of excitation,” as Freud put it very early (188), rather than the aim of 
the total abolition of all tension (517). 

It can be seen everywhere that this principle of hopieostasis does not remain 
unopposed. Some behavior «cems to be directed not toward getting rid of ten- 
sions but rather toward creating new tensions, and the main task of psychology 



DYNAMIC, ECONOMIC, STRUCTURAL POINTS OF VIEW 13 

is to study and understand counterforces that tend to block or to postpone im- 
mediate discharge. 

However, this understanding will never be arrived at if an attempt is made to 
differentiate a “homeostatic instinct” from other ‘‘nonhomeostatic instincts’* 
(i2ii). Homeostasis is, as a principle, at the root of all instinctual behavior; the 
frequent “counterhomeostatic” behavior must be explained as a secondary com- 
plication, imposed upon the organism by external forces. 

fust as there is no homeostatic instinct but only a homeostatic principle at the 
basis of all instinctual behavior, there is likewise no “instinct to master,” as dis- 
tinguished from other instincts (766, 767, 768). Mastery means the ability to han- 
dle outer demands and inner drives, to postpone gratification when necessary, to 
assure satisfaction even against hindrances; it is a general aim of every organism 
but not of a specific instinct. However, there is no doubt that there is a “pleasure 
of enjoying one’s abilities,” that is, of enjoying the cessation of the tension of “not 
being able yet,” the cessation of anxiety connected with insufficiency of motor 
control. 

Thus the forces whose interaction is supposed to explain the actual mental phe- 
nomena have definite directions— tow zxdi motility or away from motility. The im- 
pulses toward discharge are representative of a primary biological tendency; the 
opposite impulses are brought into the organism by influences from the outside. 

Slips of the tongue, errors, symptomatic acts are the best examples of conflicts 
between strivings for discharge and opposing forces; some tendency that has been 
warded off, either definitely by “repression” or by a wish not to express it here 
and now, finds a distorted expression counter to the opposing conscious will 
( 553 ). 

When tendencies to discharge and tendencies to inhibit are equally strong, 
there is externally no evidence of activity; but energy is consumed in an internal 
hidden struggle. Clinically this is manifested by the fact that individuals sub- 
ject to such conflicts show fatigue and exhaustion without doing perceptible 
work. 


MENTAL ECONOMICS 

With this example we find ourselves in the field that Freud has called psycho- 
economics (588). The above-mentioned persons were tired because they were 
consuming energy in a struggle between inner forces. When a person suppresses 
an irritation and subsequently in another situation reacts violendy to an insig- 
nificant provocation, it must be assumed that the first quantity of irritation, 
which was suppressed, was still at work in him as a readiness to discharge, later 
seizing the first possible opportunity. The energy of the forces behind the mental 
phenomena is displaceable. Strong impulses demanding discharge are more dif- 



14 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

ficult to restrain than weak ones; however, they can be restrained if the coun- 
terforces are equally strong. What quantity of excitation can be borne without 
discharge is an economic problem. There is a mental energy exchange, an eco- 
nomic distribution of the energy at hand between intake, consumption, and out- 
put. Another example of the usefulness of the economic concept is seen in the 
fact that neuroses frequently break out at puberty and at the climacterium. The 
person affected was able to withstand a certain amount of undischarged in- 
stinctual excitation; however, when physical changes increased the absolute 
quantity of this excitation, the countermeasures no longer sufficed. Countless 
other examples exist which bring home tlie importance of the economic point of 
view for the understanding of factually observed phenomena. The person who 
was tired after having done nothing represents but a special type of general 
inhibitions due to silent internal tasks. Those who have inner problems to solve 
must apply a great deal of their energy to them, and there remains little for 
other functions. 

The concept of a “quantity” of mental energy is exactly as justifiable or un- 
justifiable as the introduction of other scientific working concepts that have 
proved practical. It is regrettable that this quantity cannot be measured directly; 
it may be measured indirectly by its physiological manifestations. 


CONSCIOUS AND UNCONSCIOUS 

In the exposition of the dynamics and economics of the mental organization, 
nothing has been stated as yet about the significance of whether a given phe- 
nomenon is conscious or unconscious. This is due to the fact that the differentia- 
tion is initially purely descriptive, not quantitative. Posthypnotic suggestion dem- 
onstrates the existence of a psychic unconscious before our very eyes. The for- 
getting of a name makes us feel it subjectively. One knows that one knows the 
name and still one does not know it. 

When the dynamic and the economic points of view are applied, the problem 
of conscious or unconscious should be put in the following way : Under what 
circumstances and through what energies does the condition of consciousness 
arise? It is in these terms that all mental qualities should be examined. Too, the 
feelings of pleasure and pain as qualities are dcscribablc only; to “explain” 
them means to determine under what dynamic and economic conditions they 
are experienced. 

This way of putting the problem would find a simple justification if a direct 
correlation could be found between fundamental quantities and the definite qual- 
ities that appeared only with them: for example, if Fechner’s hypothesis— that 
every increase in mental tension is felt as displeasure and every decrease as 
pleasure— could be confirmed. Many facts arc in accordance with such a view- 



DYNAMIC, ECONOMIC, STRUCTURAL POINTS OF VIEW ^5 

point, but unfortunately there are contradictory facts, too (555, 613). There are 
pleasurable tensions, like sexual excitement, and painful lacks of tension, like 
boredom or feelings of emptiness. Nevertheless, Fechner’s rule is valid in general. 
That sexual excitement and boredom are secondary complications can be dem- 
onstrated. The pleasure of sexual excitement, called forepleasure, turns imme- 
diately into displeasure if the hope of bringing about a discharge in subsequent 
end pleasure disappears; the pleasure character of the forepleasure is tied up 
with a mental anticipation of the end pleasure. The displeasure of boredom 
turns out, on closer inspection, not to correspond to a lack of tension but rather 
to an excitement whose aim is unconscious (422) . A further discussion of the 
problem at this point would lead us too far astray (cf. 613). It was brought up 
in order to demonstrate that attempts to co-ordinate quantitative factors and 
qualitative phenomena are warranted. 

Returning to the quality “conscious,” the fact whether or not an impulse is 
conscious reveals nothing of its dynamic value. Conscious phenomena are not 
simply stronger than unconscious bnes; nor is it true that everything uncon- 
scious is the “real motor” of the mind, and everything conscious merely a rela- 
tively unimportant side issue. The many memory traces that can be made con- 
scious by a simple act of attention are “unimportant” though unconscious (they 
are called preconscious) . Other unconscious phenomena, however, must be 
imagined as intense forces striving for discharge but kept in check by an equally 
strong force, which manifests itself as “resistance.” Unconscious material under 
such high pressure has only one aim: discharge. Its freely floating energy is 
directed according to the “primary process”; that is, it is unburdened by the de- 
mands of reality, time, order, or logical considerations; it becomes condensed and 
displaced, following only the interests of increased possibilities of discharge. This 
mode of functioning of the archaic mind remains effective in the realm of the 
unconscious; in the more differentiated parts of the mind it gradually becomes 
supplanted by the organized “secondary process” (590). 


THE MENTAL STRUCTURE 

Mental phenomena are to be regarded as the result of the interplay of forces 
pressing respectively toward and away from motility. The organism is in con- 
tact with the outside world at the beginning and at the end of its reaction 
processes, which start with the perception of stimuli and end with motor or 
glandular discharge. Freud looks at the mental apparatus as modeled after an 
organism floating in water (608). Its surface takes up stimuli, conducts them to 
the interior, whence reactive impulses surge to the surface. The surface is dif- 
ferentiated gradually with respect to its functions of stimulus perception and 
discharge. The product of this differentiation becomes the “ego.” The ego pra- 



i6 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


ceeds selectively in its reception of perceptions as well as in its allowing impulses 
to gain motility. It operates as an inhibiting apparatus which controls, by this 
inhibiting function, the position of the organism in the outside world. Alex- 
ander in his ‘Vector analysis” regards all mental tendencies as combinations of 
intake, retention, and elimination (44). We add: living begins with intake; but 
with the initial intake the first urge to eliminate appears; retention, however, 
arises later under complicating influences. 

The ego develops abilities with which it can observe, select, and organize 
stimuli and impulses: the functions of judgment and intelligence. It also de- 
velops methods of keeping the rejected impulses from motility by the use of 
energy quantities kept ready for this purpose; that is, it blocks the tendency 
toward discharge and changes the primary process into the secondary process 
(552, 590) . All this takes place by means of a special organization which aims 
to fulfill its different tasks with a minimum of effort (principle of multiple 
function) (1551). 

Underneath the organized periphery of the ego lies the core of a dynamic, 
driving chaos of forces, which strive for discharge and nothing else, but which 
constantly receive new stimulations from external as well as internal percep- 
tions, influenced by somatic factors that determine how the perceptions are 
experienced (590, 608). The organization proceeds from the surface to the 
depth. The ego is to the id as the ectoderm is to the endoderm. The ego becomes 
the mediator between the organism and the outer world. As such it has to provide 
protection against hostile influences from the environment as well as enforce- 
ment of gratification even against a restricting outside world. There is no rea- 
son to assume that the ego, created for the purpose of ensuring the gratification 
of the organism’s impulses, is in any way primarily hostile to the instincts. 

What docs the differentiation of ego and id have to do with the qualities of 
conscious and unconscious.? It would be simple if ego and conscious, id and 
unconscious could be co-ordinated. But unfortunately things are more com- 
plicated, That which takes place in consciousness consists of (corresponding to 
‘‘intake” and “discharge”) perceptions and impulses. We may regard imagery as 
consisting of impulses with a weaker cathexis (774). However, not all impulses 
and perceptions are conscious. There arc “below threshold” stimuli which can 
be proved to have been perceived without ever having been conscious (1228). 
Further, there are repressed perceptions, in hysterical blindness, for example, 
where the effectiveness of unconscious perceptions can be observed. There is 
also unconscious motility, as in somnambulism. Unconscious perceptions and 
movements have specific peculiarities which differentiate them from the con- 
scious ones. All living organisms must maintain exchanges with the outside 
world through the basic functions of perception and motility — ^this is true even 
before there is any differentiation of an ego, and in the same way that nourish- 



DYNAMIC, ECONOMIC, STRUCTURAL POINTS OF VIEW I? 

ment and breathing must be performed by each living cell even before there is a 
differential development of a multicellular respiratory and metabolic apparatus. 
Before a systematic conception of reality can be developed there must of neces- 
sity exist a certain unsystematic, perception. 

Consciousness comes into being at some point in the process of systematiza- 
tion (see p, 34). This process depends on the ability to utilize memories. Mem- 
mory traces are remnants of perceptions; they apparently arise on a second level 
below that of the perceptions themselves (522, 615). The ego broadens out from 
the layer of these memory traces, called the preconscious. The differentiation of 
the ego is a gradual process. There are deeper layers of the ego which are un- 
conscious. The transition from ego to id is a gradual one and is only sharp at 
those points where a conflict exists. However, where such conflict does arise, 
even highly differentiated forces of the ego become unconscious again. 

The portion of the conscious that is best known is the “repressed” — that 
which is unconscious because strong, dynamic forces hinder its becoming con- 
scious. The repressed pushes toward consciousness and motility; it consists of 
impulses seeking outlets. In this seeking activity it tends to produce “derivatives,” 
that is, to displace its cathexes onto associativcly connected ideas that are less 
objectionable to the conscious ego. In psychoanalysis, preconscious derivatives arc 
encouraged and caught by the patient’s attention; this is the way repressed con- 
tent gradually becomes known. The repressed consists, first of all, of the ideas 
and conceptions connected with the aim of the warded-off impulses which, by 
being warded off, have lost their connection with verbai expression; by regain- 
ing verbalization, unconscious ideas become preconscious (590). But it is also 
meaningful to talk about unconscious sensations, feelings, or emotions. Cer- 
tainly the qualities of feelings come into being only by being felt. But there 
are tensions in the organism which, were they not hindered in their discharge 
and development by blocking countercathexes, would result in specific sensa- 
tions, feelings, or emotions. They are unconscious “dispositions” toward these 
qualities, unconscious “longings for affects,” strivings toward development of af- 
fects that are held in check by opposing forces, while the individual does not know 
that he has such readiness toward rage or sexual excitement or anxiety or guilt 
feeling or whatever it may be (608) . Of course, such “unconscious dispositions 
toward affects” are not theoretical constructions but may be observed clinically 
in the same way that unconscious ideas may be observed: they, too, develop 
derivatives, betray themselves in dreams, in symptoms, and in other substitute 
formations, or through the rigidity of the opposing behavior, or, finally, merely 
in general weariness. 

The mental apparatus, however, docs not consist only of an ego and an id. 
Its further development brings a further complication. 

Previously it was stated that the question as to the nature of the forces block- 



i8 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


ing discharge was the basic one of all psychology. In the inain, these forces were 
thrust upon the mind by the environment. It is the consiclcnition of reality that 
keeps the ego from immediately complying with the discharge drive of the im- 
pulses. However, such inhibiting tendencies, which according to the definition 
are derived from the ego, are not in all respects the opposite of '‘instinctual 
drives.” Often, for example in ascetics or moral masochists, the aiui-instinctual 
behavior betrays all the characteristics of an instinct. This contradiction can be 
explained genetically. The energy with which the ego carries out its instinct- 
inhibiting activities is drawn from the instinctual reservoir of the id. A portion of 
the instinctual energy is changed into counterinstinctual energy. A certain part 
of the ego which inhibits instinctual activity develops on the one hand closer to 
the instincts and on the other hand is in conflict with other parts of the ego that 
are hungry for pleasure. This part, which has the function (among others) of 
deciding which impulses are acceptable and which are not, is called the super- 
ego. While the ego is also a representative of the outside world, here again we 
have a special representative of the outside world within the first representative 
(608). 

INITIAL ESSAY AT A DEFINITION OF NEUROSIS 

After bringing forth the dynamic, economic, and structural points of view, 
an initial attempt will be made to clarify what takes place in a neurosis. Is there 
any common denominator in the manifold neurotic phenomena that may be 
utilized for comprehending the essential nature of neuroses? 

In all neurotic symptoms something happens which the patient experiences 
as strange and unintelligible. This something may be involuntary movements, 
other changes of bodily functions and various sensations, as in hysteria; or an 
overwhelming and unjustified emotion or mood, as in anxiety spells or depres- 
sions; or queer impulses or thoughts, as in compulsions and obsessions. All 
symptoms give the impression of a something that seems to break in upon the 
personality from an unknown source — a something that disturbs the continuity 
of the personality and that is outside the realm of the conscious will. But there 
are also neurotic phenomena of another kind. In “neurotic characters’* the per- 
sonality does not appear to be uniform or disturbed only by one or the other 
interrupting event, but openly so torn or deformed and often so involved in the 
illness that one cannot say at what point the “personality” ends and the “symp- 
tom” begins. But different as “symptom neuroses” and “character neuroses” 
seem to be, both have this in common: the normal and rational way of handling 
the demands of the external world as well as the impulses from within is sub- 
stituted by some irrational , phenomenon which seems strange and cannot be 
voluntarily controlled. Since the normal functioning of the mind is governed by 
a control apparatus that organizes, leads, and inhibits deeper archaic and more 



DYNAMIC, ECONOMIC, STRUCTURAL POINTS OF VIEW 19 

instinctual forces— in the same way that the cortex organizes, leads, and in- 
hibits impulses of the deeper and more archaic levels of the brain— it can be 
stated that the common denominator of all neurotic phenomena is an insuf- 
ficiency of the normal control apparatus. 

The simplest way to “control” stimuli is to discharge by motor reactions the 
excitation they arouse. Later the immediate discharge is replaced by more com- 
plicated control mechanisms of counterforces. This control consists in a dis- 
tribution of counterenergies in an adequate economic stability between incom- 
ing stimuli and outgoing discharges. 

All neurotic phenomena are based on insufficiencies of the normal control 
apparatus. They can be understood as involuntary emergency discharges that 
supplant the normal ones. The insufficiency can be brought about in two ways. 
One way is through an increase in the influx of stimuli: too much excitation 
enters the mental apparatus in a given unit of time and cannot be mastered; 
such experiences are called traumatic. The other way is through a previous 
blocking or decrease of discharge which has produced a damming up of tensions 
within the organism so that normal excitations now operate relatively like 
traumatic ones. These two possible ways are not mutually exclusive. A trauma 
may initiate an ensuing blocking of discharge; and a primary blocking, by 
creating a state of being dammed up, may ause subsequent average stimuli to 
have a traumatic effect. 

A model of the first type can be seen in irritations that everyone experiences 
after little traumata, like a sudden fright or some smaller accident. The person 
feels irritated for a certain time, cannot concentrate because inwardly he is still 
concerned about the event and has no energy free for attention in other direc- 
tions. He repeats the event in his thoughts and feelings a few times— and after a 
short while his mental stability is re-established. Such a little traumatic neurosis 
can be explained as flooding of the organism by amounts of unmastered excitation 
and as attempts at a belated mastery. The severe traumatic neuroses must be 
looked at from the same angle (w pp. iiyff.). 

A model of the second type of neurosis, characterized by a previous blocking 
of discharge and called psychoneurosis, is represented by the artificial neuroses 
that have been inflicted upon animals by experimental psychologists (65, 286, 
923, 1109). Some stimulus which had represented pleasant instinctual experi- 
ences or which had served as a signal that some action would now procure 
gratification is suddenly connected by the experimenter with frustrating or 
threatening experiences, or the experimenter decreases the difference between 
stimuli which the animal had been trained to associate with instinct gratification 
and threat respectively; the animal then gets into a state of irritation which is 
very similar to that of a traumatic neurosis. He feels contradipory impulses; the 
conflict makes it impossible for him to give in to the impulses in the accustomed 



20 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


way; the discharge is blocked, aad this decrease in discharge works in the same 
way as an increase in influx; it brings the organism into a state of tension and 
calls for emergency discharges. 

In psychoneuroses some impulses have been blocked; the consequence is a 
state of tension and eventually some “emergency discharges.” These consist 
partly in unspecific restlessness and its elaborations and partly in much more 
specific phenomena which represent the distorted involuntary discharges of those 
very instinctual drives for which a normal discharge has been interdicted. Thus 
we have in psychoneuroses, first a defense of the ego against an instinct, then a 
conflict between the instinct striving for discharge and the defensive forces of the 
ego, then a state of damming up, and finally the neurotic symptoms which are 
distorted discharges as a consequence of the state of damming up— a compro- 
mise between the opposing forces. The symptom is the only step in this develop- 
ment that becomes manifest; the conflict, its history, and the significance of the 
symptoms are unconscious. ' 

NEUROTIC SYMPTOMS AND AFFECTS 

These considerations of the essence of the neuroses call forth an objection that 
should not be overlooked. Much of the given characterization of neurotic phe- 
nomena seems valid also for a category of very normal mental phenomena, 
liamely, of affective or emotional spells. 

Actually a search for a common denominator for all sudden outbursts of 
affect reveals a close relationship between outbursts of this kind and neurotic 
phenomena. 

Affective spells consist of (a) movements and other physiological discharges, 
especially changes in the muscular and glandular functions, and (b) emotional 
feelings. Both the physical and the mental phenomena are specific for any given 
affect— and in particular the correlation of both phenomena is specific. Emo- 
tional spells occur without the consent or even against the will of the individual; 
persons who undergo emotional spells have “lost control.’^ Apparently something 
of a more archaic nature is substituted for theu normal ego— there is no doubt 
that children and infantile personalities are more unstable emotionally. 

Such spells occur as a response to (a) extraordinarily intense stimuli, the quan- 
tity of which explains the temporary insufficiency of the normal control apparatus 
of the ego; in this case the emotional spells seem to be a kind of emergency con- 
trol supplanting the normal ego control; or (b) to ordinary stimuli when certain 
conditions obtain in the organism. The simplest example is displaced rage. A 
slight precipitating factor evokes a fit of anger if there was a readiness for it in the 
organism rooted in a previous experience that afforded this tendency no means 
of expression. In general the organism tends toward emotional regressions if it 



DYNAMIC, ECONOMIC, STRUCTURAL POINTS OF VIEW 21 

is in a state o£ tension* This is why an unduly intense emotional reaction generally 
can be regarded as a ‘‘derivative” of something that was previously suppressed. 
In summary, emotional spells occur when the normal ego control has been 
rendered relatively insufficient by (a) too much influx of excitation, or (i) a 
previous blocking of the efflux (191, 440, 697, 1013, loai). 

This definition is identical with that given for neurotic symptoms. The neurotic 
symptoms, too, arc discharge phenomena that occur without the consent of the 
ego; and if their precipitating factors, too, are analyzed, either an increased in- 
flux of excitation (traumatic neuroses) is found or defense activities of the 
ego that had previously blocked discharges and thus brought the organism into 
a state of tension (psychoneuroses) . Thus the causation of emotional spells and 
of neurotic symptoms is essentially the same: a relative insufficiency of ego con- 
trol because of either increased influx or blocking of discharge. Both emotional 
spells and neurotic symptoms arc partial substitutes, of a more archaic nature, for 
the normal ego motility. Neurotic symptoms could be called a kind of “personally 
structured” affective spells. The difference lies in the nature of what is substituted. 
In neurosis the substitute is subjectively determined in the history of the individ- 
ual. In affect the substitute is objectively determined; the syndrome is more or less 
the same in different individuals and is caused by chemically induced nervous re- 
actions — ^just where it comes from, we do not know. The impression that there is 
a general similarity between neurotic and emotional spells impelled Freud, after 
having discovered the historical determination of the hysterical fit, to look for 
a historical determination of the anxiety syndrome also (618). 

The similarity between neurotic symptoms and emotional spells seems less 
striking in the case of compulsive symptoms. However, the compulsive symptom 
is less primitive than other neurotic symptoms; it is not a simple breaking 
through of the repressed forces. Similarly, not all affects have the character of 
sudden spells; the compulsive symptoms may be compared to tension affects 
like grief. If a conversion symptom corresponds to an outburst of intractable 
sexual excitement or of rage, then the compulsive symptom is paralleled by the 
more gradual work of mourning. Both compulsion and mourning represent a 
secondary elaboration of the original tendency toward stormy discharge. 
iThe psychoneuroses are essentially the result of a conflict between instinctual 
demands and defensive forces of the ego. This knowledge shows how best to 
organize a theory of neurosis. To be studied are (a) the defending ego and its 
development, (^) the instincts and their development, (c) the types of conflicts 
between the two, their motives, methods and manifestations, and (d) the conse- 
quences of the conflicts, the neuroses proper. 

However, these four points cannot be strictly separated from each other; they 
are too closely interwoven. We shall have to deal with the same facts repeatedly, 
looking at them from different angles. The interrelationship between ego and 



22 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


id makes it necessary to subdivide the ego chapter; first the early stages of de- 
velopment of the ego will be taken up, next the development of tlie instincts, 
and only then the later development of the ego, A brief chapter about the 
psychoanalytic method of research precedes the discussion of mental develop- 
ment. 



Chapter III 

THE METHOD OF PSYCHOANALYSIS 


INTRODUCTORY REMARKS 

What follows is neither a presentation of the technique of psychoanalysis nor an 
explanation of the therapeutic procedure. The former is beyond the scope of this 
book and the latter will be discussed later (Chapter Twenty-three) . Only a few 
basic facts will be presented concerning the scientific method used in gathering 
the psychological and psychopathological findings that are to be discussed (r/. 
748, 779)- 

Today the presentation of the principles of the psychoanalytic method is easy. 
Historically they were gradually developed out of the needs of psychothera- 
peutic practice (188). Every bit of newly acquired method brought forth new 
findings which again could be used in improving the method. Today it is possible 
to justify the method by explaining its theoretical background. Actually the 
theory did not precede the method; rather, it was established with the help of 
the method. 


THE BASIC RULE 

Dynamic psychology has the task of reconstructing, from certain given mani- 
festations, the constellation of forces that produced the manifestations. Behind 
the changing manifest picture are its dynamic foundations, impulses striving for 
discharge and inhibiting counterforces. The initial efforts of the analyst are 
devoted to eliminating obstacles that prevent a more direct expression of these 
forces. He undertakes to achieve this by the so-called basic rule. The patient is 
requested to say everything that enters his mind, without selection. 

To understand the meaning of this rule, we should recall how a person acts 
in everyday life who does not follow the rule. His impulses toward actions or 
words are determined by (a) external stimuli of any kind to which he reacts, 
(b) his physical state which gives him internal stimuli and determines the in- 
tensity and mode of the impressions by external stimuli, (c) certain conceptual 
goals, the thought of what he wants to do or say, which makes him suppress that 
which does not belong to the subject, and (d) the derivatives of all the warded- 
o£E impulses that try to find discharge. 

The psychoanalyst wants to understand the last group of determinants and 
for this purpose tries to exclude the first three as much as possible, with the aim 
of making this last more recognizable. The external stimuli during the psycho- 
analytic hour are reduced to a minimum and remain relatively constant. 



^ THE PSYCHOANALYTIC THEORY OF NEUROSIS 

In his earlier days Freud even asked patients to close iheir eyes for the purpose 
of excluding distracting visual perceptions (543, 544). Later, however, it turned 
out that the danger of inducing the patient to isolate the analytic procedure from 
“open-eye reality’* is usually greater than the possible gain. 

An acute extraordinary physical state, such as pain, hunger, or an impending 
real danger, actually is a hindrance to the production of fruitful associations be- 
cause it overshadows the production of derivatives, 

A patient used to dream exclusively about food, and the analysis apparently 
made no progress. It turned out that he actually did not have enough to cat. Alter 
he succeeded in getting a job, die “oral” dreams disappeared and the analysis 
went on normally. 

The elimination of the third disturbing factor, the conscious conceptual goals 
of the ego, is the main object of the basic rule. When the selective conceptual 
goals of the ego are excluded, what is expressed is determined rather by tensions 
and impulses within the individual awaiting the opportunity to gain expression. 
The analyst tries to make the patient learn to eliminate the conceptual goals and 
not to select the things he tells. In fact, the patient is not to be active at all; his 
one task is not to prevent the expression of impulses that rise within him. 

“To tell everything” is much more difficult than one imagines. Even the in- 
dividual who conscientiously tries to adhere to the basic rule fails to tell many 
things because he considers them too unimportant, too stupid, too indiscreet, and 
so on, There are many who never learn to apply the basic rule because their fear 
of losing control is too great, and before they can give expression to anything, 
they must examine it to see exactly what it is. 

It is, therefore, not so simple for the unconscious to find expression simply by 
attempting to obey the basic rule. It is true that the regulation eliminates thou- 
sands of conceptual goals of everyday life, but it cannot eliminate all the counter- 
forces of the ego. Even if it were possible to cut off all purposeful thinking 
and to concentrate only on what comes up spontaneously, still the pure drives 
striving for discharge would not be encountered. The very strongest and 
deepest resistances— that is, those that originated in childhood and that arc 
directed against unconscious instinctual outbursts— cannot be swept out of ex- 
istence by a stipulation to tell everything. Thus the utterances of a patient 
obeying the rule are not simply a reflection of the unconscious that now becomes 
conscious. The "picture presented is, rather, one of a struggle between certain 
unconscious impulses (which reveal themselves relatively more clearly in analy- 
sis than in ordinary conversation) and certain resistances of the ego, which like- 
wise are unconscious to the subject or become apparent to him in distorted form 
only. In the patient’s expressions, minima and maxinoa of an approach to some- 
thing “really meant” can be recognized. 



THE METHOD OE PSYCHOANALYSIS 


^5 


INTERPRETATION 

Now, what does the analyst do? (i) He helps the patient eliminate his re- 
sistances as far as possible. Though he may apply various means, fundamentally 
the analyst calls the attention of the patient, who is either completely unaware 
or insufficiently aware of his resistances, to the effects of his resistances. (2) 
Knowing that the utterances of the patient are really allusions to other things, 
the psychoanalyst tries to deduce what lies behind the allusions and to impart 
this information to the patient. When there is a minimum of distance between 
allusion and what is alluded to, the analyst gives the patient words to express 
feelings just rising to the surface and thereby facilitates their becoming conscious. 

This procedure of deducing what the patient actually means and telling it 
to him is called interpretation. Since interpretation means helping something 
unconscious to become conscious by naming it at the moment it is striving to 
break through, effective interpretations can be given only at one specific point, 
namely, where the patient’s immediate interest is momentarily centered. The 
actual shocking infantile instinctual impulses are so far removed from the possi- 
bility of being felt that, in the beginning, interpretation is of course not con- 
cerned with them but rather with their derivatives. Defensive attitudes are closer 
to the patient’s capacity to understand and so are interpreted first. 

It has been asked why the theoretical knowledge about content and mech- 
anisms of neuroses cannot be applied toward shortening the regrettably long time 
required by psychoanalysis. If it is known that the basis of a neurosis is the 
so-called Oedipus complex, why not tell the patient immediately that he loves 
his mother and wants to kill his father, and cure him by this information ? There 
was once a comparatively large school of pseudo analysis which held that the 
patient should be “bombarded” with “deep interpretations” (1479); and even 
psychoanalytic literature contains statements to the tSept that a speedy, “deep 
interpretation” can overcome the patient’s anxiety (958). Efforts of this kind 
remain necessarily unsuccessful. The unprepared patient can in no way con- 
nect the words he hears from the analyst with his emotional experiences. Such 
an “interpretation” does not interpret at all. 

Even the mere^information that something within him is fighting his adher- 
ence to the basic rule tends to make the patient discover something in himself 
of which he was previously unaware. An interpretation that directs the patient’s 
attention to something hitherto unnoticed serves the same purpose as does the 
histology teacher who tells his pupils what to look for in the microscope. Of 
course it is not mere lack of experience that prevents the analysand from noting 
his attitude. There are powerful motives that make him unwilling to know. 

Actually resistances are attacked not only by interpretation; other means of 
influencing people to do something unpleasant are used as well, The analyst 



26 the psychoanalytic theoky of neurosis 

tries to convince the patient that the unpleasant task is necessary; his friendly 
feelings toward the analyst are utilized. However, wherever possible, inter- 
pretation is used. The concurrence of perceiving the interpreter’s words and 
the preconscious presence of the derivative in statu nascendi changes the dynamic 
conflict between defense and warded-off inapulses in favor of the latter and new, 
less distorted derivatives can be tolerated. The interpretation splits the ego into 
an observing and an experiencing part so that the former can judge the irrational 
character of the latter. 

How can the analyst know what the words of the patient actually allude to? 
Resistances have twisted his utterances beyond recognition. It is the task of the 
analyst’s interpretative work to undo and make retroactive the distortion caused 
by resistances. This work of reconstruction has often rightly been compared to 
the interpretation of archaeological findings. It can be more readily dem- 
onstrated with examples of errors, slips of the tongue, and dreams than with 
neuroses in toto (553). 


DEVICES OF DISTORTION 

There are many ways in which distortion is brought about. A few examples 
of the devices employed in distortion may be enumerated: 

1. Links may be missing in the associations of the patient which, when exam- 
ined, reveal themselves as being connected with affects, specific recollections, or, 
generally, specific attitudes that may be expected in certain situations. When the 
analyst observes such hiatuses, he knows that the censoring forces of the ego 
have been busy with their scissors. 

2. Affects that have once been suppressed express themselves in some other 
connection. If a man must swallow his anger at his boss, he may easily become 
enraged at his wife. Therefore, when the analyst observes that an affect is incom- 
mensurate with a given situation — whether it be too strong or whether it be 
different in quality — he knows that he is dealing with a derivative of something 
else. 

3. Not only affects may reveal themselves as “substitutes”; the distortion may 
also consist in replacing any idea with another one which is associatively con- 
nected. Whatever the patient expresses, not only in words but also in movements, 
attitudes, errors, may be allusions to something else. The associative connec- 
tions are of various kinds. Allusions and what is alluded to may have common 
or similar characteristics. What is said and what is meant may represent differ- 
ent parts of one and the same whole. So long as the analyst does not know the 
whole, he cannot surmise what is meant. The more the analyst knows about the 
history of his patient, the better he can understand. Neurotic symptoms, espe- 
cially, often become understandable only through their historical connections. 



THE METHOD OF PSYCHOA.NA.LYSIS 


27 


Since the unconscious continually strives for expression, the best way for the 
analyst to find out what is actually meant is to look for a common factor in the 
various utterances of the patient. Frequently it is the interplay or the contradic- 
tion between the patient’s various statements or between his words and his ges- 
tures or between his words and his feelings that puts the analyst on the right trail. 
At times the very manner in which the patient relates something or experiences 
something must itself be interpreted as the expression of a specific unconscious 
thought. Also to be noted is the fact that everyone shares a common reservoir 
of expressions that serve to distort meaning— symbolism. 

The interpretative work of the analyst does not, of course, consist in stopping 
to examine every utterance of the patient by saying to himself: “Did he omit 
something here? Is the patient’s remark only a fragment of some complete train 
of thought? Perhaps I must find some historical connection in it. What is the 
connection between the patient’s utterance and what he said five minutes ago, 
or yesterday? Is the patient’s facial expression in harmony with or in contradic- 
tion to what he is saying ? Is that which he just mentioned to be found in Freud’s 
table of symbols? Is his affect commensurate with his utterance?” and so on. 
By the time the analyst considers all these points the patient will have gone on 
to something else. No, discovering what the patient really means does not involve 
the conscious analysis of all possible distortions but rather an intense empathy 
with the personality of the patient. In performing this part of his task the tool 
of the analyst is his own unconscious. 

Does this admission deny the scientific character of the psychoanalytic method? 
How can the analyst, working with his intuition, actually know if that which he 
has surmised is really correct? The answer to this question may be postponed for 
the time being. 

An interpretation, it has been stated, can only be effective if it is given at the 
moment when the distance between what is said and what is meant is at a mini- 
mum. How can the analyst know when to interpret? He must constantly have 
an awareness of the strength of the resistances operative at any given moment. 


TYPES OF RESISTANCES 

Resistances find expression in manifold ways. Everything that prevents the 
patient from producing material derived from the unconscious is resistance. It 
is impossible to tabulate the various ways in which resistance can be expressed. 
The patient may stop talking, or he may talk so much that a common factor 
cannot be deduced from his utterances. What he says appears to deviate further 
and further from what he actually means; it seems to be extensive rather than 
deep. 



28 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 

I£ we call the patient’s attention to this, he may reply: “You asked me to say 
everything that comes to my mind. If my associations tend to spread out in all 
directions, should I therefore abandon the basic rule of analysis?” The answer 
is simple: The patient must follow the basic rule as closely as he can. If, however, 
no common factor develops, the analysis is confronted with an antecedent prob- 
lem, which must be recognized before what is actually meant can be surmised: 
Why do the patient’s associations extend in all directions.? Both the analyst and 
the patient must co-operate to find out why the patient expresses his resistance in 
this specific form. 

The patient may forget certain things, important events of the day before, or 
something that has already been discussed in the analysis. He may criticize every 
comment of the analyst; he may feel antagonistic or ill at case. 

It is the aim of analysis to demonstrate to the patient the disturbing residues 
of the past in his present feelings and reactions— to connect the present with the 
past. Thus a certain form of resistance consists in the patient’s talking only about 
the present and refusing to see the past; in the converse form of resistance the 
patient talks only about childhood memories and refuses to see their representa- 
tions in present reality. 

It is the aim of analysis to confront the patient’s reasonable ego with the irra- 
tional emotions effective within him. Thus a certain form of resistance consists 
in the patient’s always being reasonable and refusing to have any understanding 
for the logic of emotions; in the opposite type of resistance the patient floats con- 
tinuously in unclear emotional experiences without getting the necessary dis- 
tance and freedom which would permit him to look at them reasonably. 

All these are forms of resistance that are easily recognizable as such. Some 
resistances, however, operate far more secretively. A patient may, for example, 
appear to be doing good analytic work; he may make progress in understanding 
the forces working within him, sense connections, and dig up new childhood 
recollections— and yet there is no change in his neurosis. This may be due to the 
operation of various hidden resistances. A certain attitude of the patient, which 
itself has not been analyzed, may nullify the effect of the analysis. For instance, 
he may have a feeling of doubt : ‘‘That would all be very fine if it were true, but 
I don’t know if it is true.” Or the patient may have understood what his associa- 
tions and the analyst’s interpretations showed him and yet the knowledge re- 
mains entirely separated from his real life. It is as if he said to himself: ‘This is 
all valid only as long as I lie on the couch.” Or a patient may accept everything 
the analyst tells him merely as a matter of courtesy; but it is just this courteous 
attitude which protects him from reliving to the full his instinctual conflicts, and 
which therefore must first be analyzed. There are intellectual resistances in which 
patients try to refute the theoretical validity of psychoanalysis instead of seeking 
to clarify their own mental life, feut there arc also intellectual resistances of the 



THE METHOD OP PSYCHOANALYSIS 


29 


reverse type: some patients become enthusiastic supporters of psychoanalysis in 
order to avoid applying it to themselves. 

An acute resistance, one that is directed against the discussion of some par- 
ticular topic, is far easier to handle than '‘character resistances.” These are atti- 
tudes which the patient had previously developed in order to maintain his re- 
pressions, and which he now exhibits toward the analyst. These attitudes must 
first be broken down before the repressions can be resolved. 


TRANSFERENCE 

'The repetition of previously acquired attitudes toward the analyst is but one 
example of the most significant category of resistance, the handling of which 
is the core of analysis: the transference resistance. Understanding the contents 
of the patient’s unconscious from his utterances is, relatively, the simplest part 
of the analyst’s task. Handling the transference is the most difficult. 

It seems very natural that in the course of an analytic treatment the patient 
should produce powerful affects. They may appear as anxiety or joy, as an in- 
crease in inner tension beyond the point of endurance, or as a happy feeling 
of complete relaxation. They may also take the form of specific feelings toward 
the analyst: an intense love, because the analyst is helping him, or bitter hatred, 
because the analyst forces him to undergo unpleasant experiences. But the prob- 
lem becomes more complicated when a patient’s affect is in contradiction to 
what is happening in the analysis, as, for example, when a patient hates the 
analyst for helping him, or loves him for imposing an unpleasant restriction. 
The problem is even more complicated when the patient obviously misconstrues 
the real situation and loves or hates the analyst for something which, in the judg- 
ment of the analyst, is nonexistent. Such misconstruing of the actual psycho- 
analytic situation is a regular occurrence in almost every analysis. Freud was at 
first surprised when he met with this phenomenon (577) ; today Freud’s dis- 
coveries make it easy to understand it theoretically. The analytic situation in- 
duces the development of derivatives of the repressed, and at the same time a 
resistance is operative against it. The derivatives may make their appearance 
as highly concrete emotional needs directed toward the person who happens to 
be present. Resistance distorts the true connections. The patient misunderstands ^ 
the present in terms of the past; and then instead of remembering the past, 
he strives, without recognizing the nature of his action, to relive the past and 
to live it more satisfactority than he did in childhood. He “transfers” past at- 
titudes to the present. 

In analysis, transference has a twofold aspect. Fundamentally it must be con- 
sidered as a form of resistance. The patient defends himself against remem- 
bering and discussing his infantile conflicts by reliving them. Transference 





THE PSYCHOANALYTIC THEOliY OF NEUROSIS 


actions (since the object is not the right one and the situation is not fitting) 
serve the purpose of distorting the original connections, and the discharge thus 
attained is necessarily insufficient. The analysancl, seeking immediate satisfaction 
of derivatives instead of facing his original impulses, attempts to use a short- 
circuit substitute for his repressed drives. On the other hand, the transference 
oifers the analyst a unique opportunity to observe directly the past of his 
patient and thereby to understand the development of his conflicts. 

In everyday life, too, there are transference situations. It is a general human 
trait to interpret one’s experiences in the light of the past. The more that repressed 
impulses seek expression in derivatives, the more hampered is the correct evalua- 
tion of the differences between the present and the past, and the greater is the 
transference component of a person’s behavior. However, the psychoanalytic 
situation in particular promotes the production of transference in two ways: 
(i) The environment which is reacted to has a relatively uniform and constant 
character and therefore the transference component in the reactions becomes 
much more pronounced. (2) Whereas in other situations people react to a per- 
son’s actions and words—thus provoking new reactions and creating new reali- 
ties all of which obscures the transference character of the original action — the 
analyst, in contrast to this, provides no actual provocation to the patient anti 
responds to his affective outbursts only by making the patient aware of his 
behavior. Thus the transference character of the patient’s feelings becomes 
clearer. The analyst’s reaction to transference is the same as to any other attitude of 
the patient: he interprets. He sees in the patient’s attitude a derivative of uncon- 
scious impulses and tries to show this to the patient. 

Practically, this task is far more difficult than any other type of interpretation. 
Were the analyst to behave as the patient’s parents had previously done, he 
could not help him, for then what had occurred in the patient’s childhood would 
merely be repeated. And were the analyst to behave in a contrary way, he would 
not be able to cure the patient either, for then he would only be fulfilling the 
patient’s resistance wishes. The analyst, therefore, must do neither the one nor 
the other. If he were to feel flattered by the love of the patient and responded in 
kind, or if he were hurt by the patient’s feeling of hate, in short, if he were to 
rpact to the affects of his patient with countcraficcts, he could not successfully 
interpret; for the patient could respond to interpretations in some such way 
as: “No, I love you or hate you not because of unresolved love or hate tendencies 
of my past but because you have actually behaved in a lovable or hateful way.’* 

There are several reasons why analytic institutes require that all analysts 
thenaselves first be analyzed. One of the reasons is that in psychoanalytic courses 
it is not possible to give clinical demonstrations, and consequently the future 
analyst can learn analytic technique only by personal ocperience. A second rea- 
son is that the analyst’s own repressions would make him overlook certain 



THE METHOD OF PSYCHOANALYSIS 


31 


things in his patient, or see others in an exaggerated way and therefore falsify 
their significance. Much more fundamental is a third reason. It is not easy to 
face the innumerable and various affects with which patients bombard the 
analyst without reacting with counteraffects, whether conscious or unconscious. 
The unconscious tendencies of the analyst to express his own unresolved love 
and hate tendencies by reacting to transference with countertransference must 
therefore be eliminated through a training analysis. 

Systematic and consistent interpretative work, both within and without the 
framework of the transference, can be described as educating the patient to 
prooduce continually less distorted derivatives until his fundamental instinctual 
conflicts are recognizable. Of course, this is not a single operation resulting 
in a single act of abreaction; it is, rather, a chronic process of working through, 
which shows the patient again and again the same conflicts and his usual way of 
reacting to them, but from new angles and in new connections. 

CRITERIA FOR THE CORRECTNESS OF INTERPRETATIONS 

The problem of how the analyst knows his interpretations are correct has 
been postponed until now. A familiar objection made to psychoanalysis is that 
interpretations are arbitrary, that the analyst more or less projects his own 
fantasies onto the patient. He is said to make things easy for himself: if the 
patient says “yes” to an interpretation, that is taken as a proof of its validity; if 
he says “no,” he thereby shows a resistance to the interpretation, proof positive 
of its validity. As for scientific certainty, there simply is no evidence of it. 

What is the real situation? As a matter of fact, it is correct that a patient’s yes 
usually is accepted as a confirmation and that, under certain circumstances, a 
no is not regarded as a refutation. Freud very rightly called attention to an 
analogous situation, that of the judge (596). The confession of an accused per- 
son is generally valid as proof of guilt, although in exceptional cases the confes- 
sion may be false; but a denial on the part of the accused is by no means proof of 
innocence. The difference between the accused and a psychoanalytic patient is 
merely that the former consciously conceals the truth, the latter unconsciously. 

Hence neither a yes nor a no in reply to an interpretation is a final criterion as to 
its validity. It is rather the manner in which the yes or no is expressed. Certainly 
there is a kind of no that merely represents a final attempt to maintain an 
attitude that has become insupportable. There are various signs by which such 
a patient betrays, immediately after uttering his no, that he has been inwardly 
affected by the interpretation and feels that what the analyst has called to his 
attention really exists within himself. But in general one can say that an inter- 
pretation to which the patient objects is wrong. That docs not necessarily mean 
that it is wrong in content, that, for instance, the impulse which the analyst sur- 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


32 

mised and imparted to the patient had never been operative. The interpretation 
may be correct in content but incorrect dynamically or economically, that is, 
given at a moment when the patient could not grasp its validity or get any 
farther with it. Sometimes a yes may be simulated by the patient out of politeness 
or negligence or fear of the consequences of a contradiction or for some other 
reason, whereas his behavior may show that inwardly he is saying no. 

To put it differently, it is not a matter of the words used by the patient in 
responding to an interpretation. In giving an interpretation, the analyst seeks 
to intervene in the dynamic interplay of forces, to change the balance in favor 
of the repressed in its striving for discharge. The degree to which this change 
actually occurs is the criterion for the validity of an interpretation. It is the pa- 
tient’s reactions in their entirety that give the answer, not his first yes or no, 
A valid interpretation brings about a dynamic change, manifested in the sub- 
sequent associations of the patient and in his entire behavior. 

Freud once compared psychoanalysis to a jigsaw puzzle, in which the aim is 
to construct a complete picture out of its fragments (550). There is but one cor- 
rect solution. So long as this is not discovered, one can pcrliaps recognize iso- 
lated bits, but there is no coherent whole. If the correct solution is found, there 
can be no doubt as to its validity, for each fragment fits into the general whole. 
A final solution reveals a unified coherence in which every hitherto incomprehen- 
sible detail has found its place. And, also before this happy point is reached, 
dynamic-economic changes in the state of the patient are decisive for determin- 
ing whether or not the procedure of the analyst is adequated 

^Many problems merely touched upon in this chapter arc discussed at some length in (438), 



B. The Mental Development 

CHAPTERS IV-VI 


Chapter IV 

EARLY MENTAL DEVELOPMENT: THE 
ARCHAIC EGO 

METHODOLOGICAL DIFFICULTIES IN THE INVESTIGATION OF THE EARLY 
PHASES OF DEVELOPMENT 

In contrast to the affect storm or emotional spell, where the phenomena are 
determined by biological and phylogenetic factors, in the neuroses the phe- 
nomena arc conditioned by the individual history. Since earlier levels of develop- 
ment are retained or returned to in neuroses, they cannot be understood without 
a thorough knowledge of these early stages. The following chapters, therefore, 
present a brief and schematic outline of mental development. 

Conclusions concerning early mental life have been very slowly worked out 
from the material gained b the analysis of adult neurotics. Later these findmgs 
were confirmed through direct observation of children. The earliest years have 
necessarily remained most obscure. First, it is not always imperative to go back 
to the earliest period in order to analyze and cure a neurosis; second, it becomes 
increasingly difficult to grasp mental reactions the further one delves into periods 
in which there is as yet no language and in which many later separate functions 
are still undifferentiated from each other. Attempts to overcome these obstacles 
by the direct observation of infants are difficult before the development of 
speech; data gained in this way allow a variety of psychological interpreta- 
tions. The temptation is great to apply concepts and ideas valid for higher 
stages of maturation to the behavior of young children. In fact it seems that this 
criticism applies to various psychoanalytic studies about the early phases of the 
ego. Few systematic observations of infants have as yet been undertaken from 
the standpoint of psychoanalysis (645, 671, 1300, 1301, 1302, 1303, 1596). Observa- 
tions made by experimental psychologists have contributed much (134, 7^4) > 
however, such research approaches the material chiefly b a way very different 
from that of psychoanalysis. 

The analysis of psychotics with their regression to primitive ego phases 
greatly increases the knowledge of these earliest stages. Analysis of psychotics 



34 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


does for the understanding of early mental development what analysis of neu- 
rotics with their return to infantile sexuality did for the understanding of the 
infantile stages of sexuality. The psychoses arc, of course, not the only states 
where regressions of the ego are observable. In the healthy person, too, archaic 
ego functions return under conditions of intoxication, exhaustion, and especially 
in the states of falling alseep and awakening (726, 837, 1546). 

THE EARLIEST STAGES 

The mental functions represent a progressively more complicated apparatus 
for the mastery of stimuli. Thus the earliest phases must be comprehended by 
means of the expressions ‘‘excitation” and “relaxation,” and only ihc later 
phases can be characterized in more definite and difiercntialed terms. 

The ego becomes differentiated under the influence of the external world. 
Correspondingly, it can be said that the newborn infant has no ego. The human 
infant is born more helpless than other mammals. He cannot live if he is not 
cared for. Innumerable stimuli pour out upon him which he cannot master. He 
is not in a position to move voluntarily and is not able to difTcrentiate the en- 
croaching stimuli. He knows no object world and has no ability yet to “bind” 
tension. One can guess that he has no clear consciousness but has at most an un- 
differentiated sensitivity to pain and pleasure, to increase and decrease of tension. 
Precisely the functions that later constitute the ego and consciousness are not yet 
developed: the taking in of the external world (perception), the mastery of the 
motor apparatus (motility), and the ability to bind tension by councercathexis. 

Of course, even prior to the development of the ego there are reactions to 
stimuli; the subsequent functions of the ego are carried out in an undifferentiated 
manner by the organism as a whole. 

The origin of the ego is not a homogeneous process. It begins with (or perhaps 
even before) birth and is in a strict sense never completed. At birth, the organism 
emerges out of a relatively quiet environment and enters an overwhelming state 
o£ stimulation with a minimum of protection from stimuli. This flooding with 
excitation without an adequate defense apparatus is, according to Freud, the 
model for all later anxiety (618). 

Probably this being flooded by excitation is highly unpleasant and evokes the 
first mental tendency, namely, the tendency to get rid of the state of tension. 
When the outside world succeeds in helping the infant cope with these stimuli 
satisfactorily, he falls asleep. New stimuli, such as hunger, thirst, cold, awaken 
him. The first traces of consciousness do not differentiate between ego and 
nonego but rather between greater and lesser tension; at this time relaxation is 
concomitant with loss of consciousness. If every need could be immediately taken 
care of, a conception of reality would probably never develop. 



EARLY MENTAL DEVELOPMEKT: THE ARCHAIC EGO 


35 


THE FINDING OF OBJECTS AND THE CONSTITUTION OF THE EGO 

The life of the infant alternates between hunger (cold and other disturbing 
stimuli) and sleep. Hunger (and disturbing stimuli) leads to a state of tension 
and thus to a tendency to get rid of the tension. It disappears with satiation, and 
sleep, a relative freedom from stimuli, sets in. The first signs of object representa- 
tion must originate in the state of hunger. When more distinct beginnings of the 
later ego functions appear, the infant’s grasping of the fact that something has 
to be done by the outside world in order to alleviate stimuli leads to the first 
longing toward objects. An object relationship of this primitive kind exists only 
as long as the object is absent. With its appearance, the longing disappears and 
sleep follows (425) . 

Before the establishment of this “first object” the infant is physically dependent 
on persons whose ministrations keep him alive. These persons, however, are 
not the infant’s objects in a psychological sense, since he is not aware of the out- 
side world but only of his own tension or relaxation. The first awareness of an 
object must come from a longing for something already familiar to the infant 
something that has the ability to gradfy needs but that is not present at the mo- 
ment (507). , j , 

The first acceptance of reality is only an intermediary step on the road to get- 
ting rid of it. This is the point at which a contradiction of basic importance in 
human life arises, the contradiction between longing for complete relaxation and 
longing for objects (stimulus hunger). The striving for discharge and relaxa- 
tion, the direct expression of the constancy principle, is necessarily the older 
mechanism. The fact that external objects brought about the desired state of 
relaxed satisfaction introduced the complication that objects became longed 
for; in the beginning, it is true, they were sought only as instruments which 
made themselves disappear again. The longing for objects thus began as a 
detour on the way to the goal of being rid of objects (of stimuli). This is prob- 
ably meant when it is sometimes stated that hate is older than love. The truth is, 
however, diat the first object relations are neither hate nor love but the still 

undifferentiated forerunner of both (79). 

The origin of the ego and the origin of the sense of reality are but two aspects 
of one developmental step. This is inherent in the definition of the ego as that 
part of the mind which handles reality (295, 700). The concept of reality also 
creates the concept of ego. We are individuals inasmuch as we feel ourselves 
separate and distinct from others. 

In the development of reality the conception of one’s own body plays a very 
special role (608). At first there is only the perception of tension, that is, of an 
‘^inside’ something.*’ Later, with the awareness that an object exists to quiet this 
tension, we have an “outside something.” One’s own body is both at the same 



3^ THE PSYCHOANALYTIC THEORY OF NEUROSIS 

time. Due to the simultaneous occurrence of both outer tactile and inner sensory 
data, one’s own body becomes something apart from the rest of the world and 
thus the discerning of self from nonself is made possible. The sum of the mental 
representations of the body and its organs, the so-called body image, constitutes 
the idea of I and is of basic importance for the further formation of the ego 
(1372). The body image does not coincide with the objective body^ for example, 
clothing or phantom extremities may be included within it (521, 1612). 

A compulsion neurotic patient was obsessively worried about his clothes which 
had to fit perfectly because otherwise he felt extremely distressed. He had a kind 
of hypochondriasis about clothes. It turned out that actually it was his physical 
well-being about which he was concerned. Something wrong with his clothes 
meant something wrong in his body. The clothes were included in his body 
image. 


EARLY PERCEPTION AND PRIMARY IDENTIFICATION 

The first state without any object representation is called primary narcissism 
(585). The first reactions to objects recognized as such contain much, integrated 
as a unit, which will later be further differentiated. These reactions arc like re- 
flexes; that is, every stimulus demands an immediate reaction, in accordance 
with the constancy principle. Stimulus intake and stimulus discharge, percep- 
tion and motor reaction stand extraordinarily close together; they arc inseparably 
interwoven. Primitive perception is precisely characterized by its closeness to 
motor reaction. One perceives by first changing one’s body through the influence 
of the perceived object— and then taking cognizance of this bodily change. Many 
perceptions usually considered optic are really kinesthetic (379, 1456). Similarly, 
eidetic research has shown that primitive optic perceptions arc bound up with 
motor reactions ready for discharge (83) ; the same is shown by the findings of 
the motor attitudes in hypnagogic and hypnopompic hallucinations (837). 

The original connection between perception and motor actiorj is also dem- 
onstrated by Freud in his paper, ‘'A Note upon the Mystic Writing Pad” (615). 
He makes clear the activity in the function of perception. As long as intensive 
stimuli from the outside world flood the organism, the organism experiences 
this passively. The construction of a perception apparatus, coinciding with an 
apparatus protecting against too intense stimuli, brings about a change from 
passivity to activity. The perceptions take place rhythmically, obviously under 
the influence of centrifugal (motor) throbs of cathexes, which may be regarded 
as a first attempt at mastering the outside world. This is the basis for the dif- 
ferentiation of systems of perception and systems of memory (552), and the 
origin of a more differentiated consciousness. After the completion of this dif- 
ferentiation, the organism is in a position to protect itself against too much influx 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 37 

of stimuli by shutting off the function of perception (917). The newly formed 
ego can again sink back into the id. This ability can be observed in fainting and 
in the symptoms of traumatic neuroses. It is clearly the model for all later defense 
mechanisms and can be applied against internal pains as well as against dis- 
pleasure of an external origin. Repression, too, may be looked upon as a specific 
blocking of the perception of particular instinctual demands. Another kind of 
return of the ego into the id takes place in sleep. 

An important function of the ego is the phenomenon of fascination which 
Bcrnfcld described (130). A primitive attempt at the mastery of intense stimuli 
consists in the primitive ego’s imitating that which is perceived. Apparently, 
perceiving and changing one’s own body according to what is perceived were 
originally one and the same thing. Goldstein’s patients with brain injury could 
compensate for their alexia by outlining the letters they saw with head move- 
ments, and then they could read by becoming aware of their kinesthetic sensa- 
tions (704, 1476) . This primitive imitation of that which is perceived is a kind 
of identification, the awareness of which brings perception. 

Another primitive reaction to the first objects appears simpler and more com- 
prehensible: the infant wants to put them into its mouth. It was hunger, repeat- 
edly disturbing the peacefulness of sleep, which compelled the recognition of 
the outside world. The experience of satiation, which first banished this tension, 
then became the model for the mastery of external stimuli in general. The first 
reality is what one can swallow. Recognizing reality originally means to judge 
whether something helps to gain satisfaction or whether it raises tensions, 
whether one should swallow it or spit it out (616). Taking-into-the-mouth or 
spitting-out is the basis for all perception, and in conditions of regression one 
can observe that in the unconscious all sense organs are conceived as mouth- 
like (420, 430). 

The primitive reactions of imitating what is perceived and the oral introjec- 
tion of what is perceived belong close together. 'Identification” in normal psy- 
chology and in psychopathology gives the impression, as Freud always em- 
phasized (606, 608), of being a regression, a “secondary” identification, repeating 
an archaic ‘‘primary” one. The concept of a primary identification denotes that 
actually “putting into the mouth” and “imitation for perception’s sake” arc one 
and the same and represent the very first relation to objects. In this primary 
identification, instinctual behavior and ego behavior are not differentiated from 
each other. It is all one; the first (oral) object love, the first motor reaction to 
external stimuli, and the first perception (408). Identifications play a great part 
in the process of building up the subsequent ego, whose nature therefore de- 
pends on the personalities of the persons around the infant (r/. loi). The imita- 
tion of the external world by oral incorporation is also the basis for the primitive 
mode of thinking, called magic, to be discussed latcn 



38 


THE PSYCHOANALYTIC THEOEY OF NEUROSIS 


This incorporation, which is the first reaction to objects in general arid the 
precursor o£ the later sexual and destructive attitudes, in a psychological sense 
destroys the existence of the object. The attitude that the object exists only for 
the ego’s satisfaction and may disappear once satisfaction is achieved can still 
be observed in some childish types of love. But the aim of the incorporation of 
objects does not necessarily reflect a subjective destructive tendency toward the 
object. This primary incorporation is the matrix of what later becomes love as 
well as destructive hate, but it is not yet either of these. An exaggerated desire to 
destroy, which actually appears in some children (and is not merely later pro- 
jected back into childhood by manic-depressive patients), is not active in every 
infant sucking at the mother’s breast. Certainly the existence of early infantile 
oral-destructive drives can be proved in pathological cases. The oral strivings of 
the normal infant do not contain such highly destructive aims and such cor- 
respondingly great fears of retaliation. Too, it must not be forgotten that incor- 
poration is only secondarily destructive, its objectively destructive nature be- 
ing used for subjective purposes; the first hostile strivings toward objects, 
which bring pain or hinder pleasure, is not to swallow them but to spit them 
out. It is also questionable whether the same object which once brought satisfac- 
tion and later refuses satisfaction is recognized as one and the same by the primi- 
tive ego; it is more likely that first there are different conceptions of a “good” 
object, which one wants to possess by swallowing, and a “bad” object, which 
one wants to spit out and only later wants to destroy by swallowing. It is a matter 
of definition whether primitive incorporation is designated “ambivalent” and 
the ambivalence of emotions thus described as “congenital.” It is ambivalent in 
so far as elements of subsequent love and hate are contained in it; it is not am- 
bivalent in so far as love and hate as opposites do not exist as yet (707). An urge 
to get satisfaction without consideration of the object (whereby the object may 
be destroyed) and an urge to destroy an object out of hate are not the same. 

To return to the study of perception: The differences between the perceptions 
of infants and of adults have the consequence that they experience the world 
differently. Observations made on psychotics, who have regressed to primitive 
modes of perception, confirm the fact that they experience the world in a more 
vague and less differentiated way. Objects are not necessarily sharply distin- 
guished from one another or from the ego or from parts of it. The first images are 
large in extent, all enveloping and inexact. They do not consist of elements that 
arc later put together, but rather of units, wholes, which only later are recog- 
nized as containing different elements. Not only arc perception and motility 
inseparable, but also the perceptions of many sense organs overlap. The more 
primitive senses, especially the kinesthetic sensations and the data of depth sensi- 
bility (proprioception) prevail. 

Besides the form of infantile perception, the contents that are perceived arc also 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 39 

diflerent. Hermann called perceptions “which the small child possesses, but 
which later disappear for inner or external reasons,” primal perceptions (778). 
The different nature of these primal perceptions is partly due to the biological 
characteristics of the child. The world appears to the child in quite another 
perspective due to his small size and to his different experience of space (134, 
1147). To a greater part the characteristics of archaic perception result from its 
unobjective character, its emotional nature. The world is perceived according 
to the instincts as a possible source of satisfaction or as a possible threat; in- 
stinctual wishes and fears falsify reality. A more objective perception presup- 
poses a certain psychological distance of the perceiving ego from the data of 
perception, a judgment about the sources of the experienced sensations and, 
more than that, a correct judgment, an ability for differential learning, whereas 
the primitive experiences are felt as still undifferentiated wholes which make 
their appearance repeatedly. The pleasure principle, that is, the need for imme- 
diate discharge, is incompatible with correct judgment, which is based on con- 
sideration and postponement of the reaction. The time and energy saved by 
this postponement are used in the function of judgment. In the early states the 
weak ego has not yet learned to postpone anything (575) . 

OMNIPOTENCE AND SELF-ESTEEM 

The primitive ego, in contrast to the more differentiated ego, is considered 
weak, that is, powerless in relation to its own instincts as well as to the outside 
world. But since the psychological separation of the ego from the external world 
is still incomplete, through comprehending the outside world or parts of it within 
itself, the ego comes to feel itself omnipotent. Ferenezi spoke of a first unlimited 
omnipotence, which persists as long as no conception of objects exists. It becomes 
limited through the experiencing of excitation which cannot be mastered and 
which leads to un-co-ordinated discharge movements. When these are under- 
stood by the environment to be a signal calling for a change in the situation, the 
child may experience this train of events as an “omnipotence of movements” 
( 457 ). 

The separation of the ego from the external world is not a sudden but a gradual 
process. 

It is, of course, also a heterogenous process, since ego-forming encounters with 
reality and with one’s own body occur in connection with manifold needs. The 
subsequent ego, therefore, has manifold “nuclei” (694, 695). A final ego is formed 
by a synthetic integration of these nuclei, and in certain states of ego regression a 
split of the ego into its original nuclei becomes observable. 

There always remain certain traces of the original objectless condition 
(878), or at least a longing for it (“oceanic feeling”) (622). Introjection is an 



4^ THE PSYCHOAKALYTIC THEORY OF NEUROSIS 

attempt to make parts of the external world flow into the ego. Projection, by 
putting unpleasant sensations into the external world, also attempts to reverse 
the separation of ego from nonego. There is a stage in develop nicnt in which 
anything unpleasant is considered nonego, anything pleasant is considered ego, 
which Freud called the purified pleasure ego (588). The most primitive method 
o£ getting rid of pain was to “hallucinate it away,” a method that quickly breaks 
down in the face of reality. Then the young organism tries to join pleasurable 
stimuli to the ego and unpleasurable ones to the nonego. In later life, traces of 
this phase are manifested in persons who without question acknowledge any 
pleasurable body sensations as “their own” but reproach aching organs as if they 
did not belong to them. Many other traces persist from the “iransitivistic” world 
in general. An example of this is presented by the child who when playing hide- 
and-gO'Seek closes his eyes and believes he now cannot be seen. The archaic 
animistic conception of the world which' is based on a confusion of ego and non- 
ego is thus illustrated; it is a kind of reverse identification. The outside world is 
perceived as having the ego’s characteristics, just as in primary identification the 
ego is perceived as having the object’s characteristics (265, 712, 802). 

When the child is forced through experiences to renounce his belief in his 
omnipotence, he considers the adults who have now become independent ob- 
jects to be omnipotent, and tries by introjection to share their omnipotence again. 
Certain narcissistic feelings of well-being are characterized by the fact that they 
are, felt as a reunion with an omnipotent force in the external world, brought 
about either by incorporating parts of this world or by the fantasy of being incor- 
porated by it (“secondary narcissism”) (608) . Religious ecstasy, patriotism, and 
similar feelings arc characterized by the ego’s participation in something unat- 
tainably high. Many social phenomena are rooted in the “omnipotents’ ” promise 
to the powerless of the desired passive participation on condition of their fulfill- 
ment of certain rules. 

The individual’s experiences connected with omnipotence lead to a most sig- 
nificant need of the human mind. The longing for the oceanic feeling of 
primary narcissism can be called the “narcissistic need.” “Self-esteem” is the 
awareness of how close the individual is to the original omnipotence (1238). 

The primitive methods of the regulation of self-esteem arise from the fact that 
the first longing for objects has the character of a longing for the removal of 
disturbing displeasure, and that the satisfaction by the object removes the object 
itself and revives the narcissistic state. The longing for the return of omnipotence 
and the longing for the removal of instinctual tension are not yet ^differentiated 
from each other. If one succeeds in getting rid of an unpleasant stimulus^ one’s 
self-esteem is again restored* The first supply of satisfaction from the external 
world, the supply of nourishment, is simultaneously the first regulator of self- 
esteem. 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 4^ 

The tendency to participate in the adult’s omnipotence after the renunciation 
of one’s own differentiates itself from the desire for the satisfaction of hunger. 
Every token of love from the more powerful adult, then, has the same effect as 
the supply of milk had on the infant. The small child loses self-esteem when he 
loses love and attains it when he regains love. That is what makes children 
edticahle. They need supplies of affection so badly that they are ready to renounce 
other satisfactions if rewards of affection are promised or if withdrawal of affec- 
tion is threatened. The promise of necessary narcissistic supplies of affection 
under the condition of obedience and the threat of withdrawal of these supplies 
if the conditions are not fulfilled are the weapons of any authority (427, 436). 

Subsequently narcissistic and sexual needs become differentiated; sexual needs 
develop in the relationship to objects, narcissistic ones more in the relationship 
between ego and superego. Every feeling of guilt lowers self-esteem; every fulfill- 
ment of ideals raises it. But since, as in all mental development, the old and primi- 
tive remain underneath the new, so a part of the relationship to objects remains 
governed by the needs of self-esteem. This is best studied in persons who are 
fixated at this level. They need a narcissistic supply from the outside in order to 
maintain their self-esteem. Among such persons there are innumerable sub- 
types. There are aggressive types who want to procure by force the essentials 
that the wicked outside world withholds, and there arc types who try to avoid 
force and instead seek the essential supplies by submissiveness and demonstration 
of suffering. Many persons try both methods simultaneously. 

The fact that erotic and narcissistic needs compel the child to ask for affection, 
and the imperative character of this longing, allows us to speak of a passive 
object love in small children. The child wants to get something from the object 
without returning anything. The object is as yet no personality but an instrument 
for providing satisfaction (73) . 

The stage of primary narcissism, in which omnipotence was felt and ‘*mas- 
tery” was no problem yet, is thus followed by a period of passive-receptive 
mastery in which difficulties are overcome by influencing powerful external 
objects to give what is needed. Whenever the subsequent active types of mastery 
fail or do not offer any hope of success, a temptation is at hand to fall back to the 
state of passive-receptive mastery. 


THE DEVELOPMENT OF MQTILITY AND ACTIVE MASTERY 

The development of active mastery is a long and complicated process. The 
mastery of the motor apparatus, too, is a task that the human infant only gradu- 
ally learns in constant connection with the maturation of the sensory apparatus. 
It is, from a psychological point of view, a gradual substituting of actions for 
mere discharge reactions. This is achieved through the interposing of a tinac 



42 


THE PSYCHOANALYTIC THEOKY OF NEUBOSIS 


period between stimulus and reaction, by the acquisition of a certain tension 
tolerance, that is, of an ability to bind primitive reaction impulses by counter- 
cathexes (575). The prerequisite for an action is, besides mastery of the bodily 
apparatus, the development of the function of judgment. This means the ability 
to anticipate the future in the imagination by ‘‘testing’’ reality, by trying in an 
active manner and in a small dosage what might happen to one passively and in 
an unknown dosage. This type of functioning is in general characteristic of 
the ego. 

Learning to walk, to be clean, and to speak are the main steps in the develop- 
ment of the mastery of physical motor functions. Walking and control of the 
sphincters form the foundation of the child’s independence; these abilities help 
to develop the reality principle (575) and to overcome receptive (Icpcncicnce and 
the necessity for immediate discharge. The faculty of speech changes the antici- 
pating functions of the ego; the establishment of name symbols for things con- 
solidates consciousness and gives the possibility of anticipating events in the 
model world of words. The ability to judge reality and the ability to tolerate 
tensions are two aspects of one and the same faculty. To direct one’s actions 
according to external necessity means to be able to foresee dangers and to fight 
or avoid them. 


ANXIETY 

f(Thc biological helplessness of the human infant brings him necessarily into 
states of painful high tension. States in which the organism is flooded by 
amounts of excitation beyond its capacity to master are called traumatic states 
(605). The pain of the unavoidable early traumatic states, still undifferentiated 
and therefore not yet identical with later definite affects, is the common root .of 
different later affects, certainly also of anxiety. The sensations of this “primary 
anxiety” can be looked upon partly as the way in which the tension makes itself 
felt and partly as the perception of involuntary vegetative emergency discharges 
(690, 993) . Freud suggested that the act of being born might be considered as an 
experience in which the syndrome of this primary anxiety is established. He had 
found that the apparently meaningless syndromes of hysterical attacks are his- 
torically determined— -that is, that they had been purposeful in a certain situation 
in the past — and his hypothesis was based on the idea that normal affects might 
have a historical origin in an analogous way (596). Certainly this primary anxiety 
is in no way created actively by the ego; it is created by external and internal 
stimuli, still unmastered, and in so far as it is experienced as i conscious painful 
feeling, it is experienced passively, as something that occurs to the ego and has 
to be endured (431, 714) . 

In later life, experiences that arc comparable to primary anxiety occur in per- 
sons who have to endure traumatic events, Uncontrollable spells of over- 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 43 

whelming anxiety, felt as something terrible that floods a helpless personality, 
form a typical symptom of traumatic neuroses. A similar type of anxiety is felt 
when sexual (and perhaps also aggressive) excitement is not permitted to, take 
its normal course. Thus it becomes probable that traumatic anxiety or panic is 
dynamically the same thing as primary anxiety — the way in which an insuf- 
ficiency of mastery, a state of being flooded with excitation, is passively and 
automatically felt. 

When the child learns to control his motility, purposeful actions gradually 
take the place of mere discharge reactions; the child can now prolong the time 
between stimulus and reaction and achieve a certain tolerance of tension. The 
characteristic capacity for “trying out” that is thus acquired changes the ego’s 
relation to its affects. Affects are originally archaic discharge syndromes that 
supplant voluntary actions under certain exciting conditions. Now the growing 
ego learns to “tame” affects and to use them for its own anticipating purposes 
(440) . This holds true also for anxiety (618) . 

With anticipatory imagination and the resultant planning of suitable later 
actions, the idea of danger comes into being. The judging ego declares that a 
situation that is not yet traumatic might become so. This judgment obviously 
sets up conditions that are similar to those created by the traumatic situation it- 
self, but much less intense. This, too, is experienced by the ego as anxiety. How- 
ever, how different is this fear as compared with the original panic! Instead of 
an overwhelming spell of anxiety, a more or less moderate fear is experienced, 
which is utilized as a signal or protective measure. This anxiety is an anticipation 
of what might happen (618). The purposeful components which appear in 
anxiety in the face of danger are to be accredited to the judging ego; the unpur- 
poseful components, like the possibility of paralysis, alrc due to the fact that the 
ego does not produce the anxiety but only uses it; it has no better means at its 
disposal (1485). 

A complication that occurs in neurotic anxiety will be met with often in the 
following chapters. Sometimes the expectation of danger, instead of precipitating 
a purposeful fear that might be used to avoid a traumatic state, precipitates a 
traumatic state itself. The ego’s judgment “danger ahead!” is followed by an 
overwhelming panic; the ego called forth something it cannot control The 
attempt at taming anxiety has failed, and the original wild panic recurs and 
overwhelms the ego. This happens if the whole organism is in a state of 
tension which could be described as a latent readiness for the development of 
panic. The ego’s judgment of danger then has the effect of a match in a powder 
barrel The intention of lighting the match as a signal fails because it frees a vast 
power, incomparably mightier than the limited powers of the force that tried to 
use the match (sed p. 133). 

The qontent of the primitive ego’s ideas of anxiety is determined in part 



44 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

directly by its biological nature and in part indirectly by its animistic ways of 
thinking, which make the ego believe that its environment has the same in- 
stinctual aims as it has itself (combined with much more power). In these 
animistic misunderstandings the primitive talion principle is at work, according 
to which any deed may be undone (or must be punished) by a similar deed 
inflicted on the original doer. 

The most fundamental anxiety is apparently connected with the infant’s 
physiological inability to satisfy his drives himself. The first fear is the (word- 
less) fear of the experience of further traumatic states. The idea that one’s own 
instinctual demands might be dangerous (which is the ultimate basis of all 
psychoneuroses) is rooted in this fear. 

However, this does not mean that the ego is hostile to instinctual impulses from 
the very beginning or always in fear of being overrun by too intense inner striv- 
ings. Since the ego learns to master and actively to satisfy its impulses, it would 
not need to produce an anxiety of this kind after having achieved this ability, and 
normal adults actually do not fear their impulses. Certain neurotics who are still 
afraid of the experience of their own excitement, at least beyond a certain intensity 
of this excitement, are so not because of a primary “anxiety of the intensity of 
their own excitement” (541) but because other types of anxiety have caused them 
to block the natural course of their excitements, turning pleasure secondarily into 
an intense displeasure (431, 1522) {see pp. 543 f.). 

This leads sooner or later to the fear that external means of satisfaction might 
possibly fail to arrive. It is the “fear over loss of love” or rather loss of help and 
protection. This fear is more intense than it would be if it represented only a 
rational judgment about real danger because the early self-esteem is regulated 
by means of external supplies so that a loss of help and protection means also a 
loss of self-esteem. An ego that is loved feels strong, a deserted one weak and 
exposed to danger. An ego that is loved fears the possibility of being deserted. 

The animistic way of thinking and feeling complicates matters. If a child fan- 
tasies devouring his environment and then meets a rebuff, he fantasies that he 
might be eaten by the parents. In this way do fantastic anxieties of physical de- 
struction originate. The most important representative of this group is castration 
anxiety, which eventually becomes the main motive for the defense activities of 
the ego (1417). 

The ways by which the normal ego learns to overcome its early and still un- 
tamed anxieties is very characteristic. Whenever the organism is flooded with a 
very large quantity of excitation it attempts to get rid of it by subsequent active 
repetitions of the situation that induced the excessive excitation. This takes place 
in the early games of little children (605, 1552) and in their dreams as well (722) . 
Between the original flood of excitation and these repetitions there is one funda- 
incntal difference : in the original experience the organism was passive; in the case 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 


45 


of the repetitions, the organism is active and determines the time and degree of ex- 
citation. At first the passive experiences that aroused anxiety are reproduced 
actively by the child in his play in order to achieve a belated mastery. Later on, 
the child in his play not only dramatizes the exciting experiences of the past but 
he also anticipates what he expects to happen in the future. The use of fear as 
a signal is but one example of the purposeful use of this anticipation. 

When the child discovers that he is now able to overcome without fear a 


situation that formerly would have overwhelmed him with anxiety, he experi- 
ences a certain kind of pleasure. This pleasure has the character of “I need not 
feel anxiety any more.” It makes the child’s play evolve from mere attempts at 
discharge to mastery of the external world by means of repeated practice. “Func- 
tional pleasure” is pleasure in the fact that the exercise of a function is now 
possible without anxiety (984), rather than the gratification of one specific type 
of instinct (766, 767, 768). It is the same pleasure that makes children enjoy the 
endless repetitions of the same game or of the same story, which has to be told 
in exactly the same words (1457). 

Economically, this pleasure can be explained in the following way. Ah ex- 
penditure of energy is associated with the anxiety or the fearful expectation felt 
by a person who is uncertain whether he will be able to master an expected 
excitation. The sudden cessation of this expenditure brings its relieving dis- 
charge which is experienced by the successful ego as a ‘"triumph” (436) and 
enjoyed as functional pleasure. Usually the pleasure originating from this source 
is condensed with an erogenous pleasure which again has become possible 
due to the overcoming of anxiety. When a child is tossed in the air by an adult 
and caught, he feels undoubtedly on the one hand erogenous pleasure in equi- 
librium (and cutaneous) sensations, and on the other hand pleasure due to an 
overcoming of the fear of falling. If he is certain that he will not be dropped, he 
can take pleasure in having thought he might have been dropped; he may shud- 
der a little, but then he realizes that this fear was unnecessary. To make this 
pleasure possible, conditions of reassurance must be fulfilled. The child must 
have confidence in the adult who is playing with him and the height must not 
be too great. Thus ip time real learning through practice occurs. When repeated 
experience has shown that the fear was groundless, the child becomes more 
courageous (423). 

Both anxiety and functioiial pleasure disappear when the ego is sure of itself 
and no longer holds an anxious expectation in readiness. Adults no longer enjoy 
any special pleasure when they engage in long-familiar and automatic activities 
which made them very proud when first accomplished In their childhood (527, 


•5 

In neurotics, however, a pathogenic defense may perpetuate childhood fears. 


The anY;<.tV s remain effective, for the most part blocking the “dangerous” 



THE PSYCHOANALYTIC THEORY OP NEUROSIS 


46 

activities entirely; sometimes, however, the waysoE figluiny anxiety arc repeated, 
too, and the ego may experience a “functional pleasure” of overcoming the fear 
by repetitions of the feared activity (435) pp. 480 iT.). 

THINKING AND THE DEVELOPMENT OF THE SENSE: OF RE.AIJTY 

The ability to recognize, to love, and to fear reality is developed in general 
before the learning of speech. But it is the faculty of speech that initiates a further 
decisive step in the development of reality testing. Words allow for a more 
precise communication with objects, and also for mahing more precise the 
anticipation by trial actions. This anticipation of action now becomes thinking 
proper and consolidates consciousness finally (500). Of course there already 
had existed a consciousness without words, which can be observed later in regres- 
sive states as “preconscious fantasy thinking” (1426, 1545, 154^, 1547). But this 
is merely the undifferentiated predecessor of thinking, in which all characteristics 
of the primitive ego are still to be seen, such as wide scope of concc[)ts, similari- 
ties taken as identities, parts as wholes, and in which the concepts are based on 
common motor reactions. Schilclcr has shown that every single thought before 
formulation, has gone through a prior wordless state (1363). 

The acquisition of the faculty of speech, of the imdcrstanding that certain 
noises are used as symbols for things, and of the gradual capacity for rational 
use of this faculty and understanding (252, 1452, 1453; cf, also 1450) is a decisive 
step in the formation of the ego. The ways by which the ego proceeds from 
integrated to differentiated, from whole units to constituent elements, from 
large scope to narrow confines, can be investigated with the help of studies of the 
phenomena of aphasia. 

Tying up words and ideas makes thinking proper possible. The ego has now 
a better weapon in handling the external world as well as its own excitations. 
This is the rational content of the ancient magical belief that one can master 
what one can name. The striving for mastery of instinctual drives in this way 
doubtless adds to intellectual development. A shift from emotional fantasy to 
sober reality takes place which serves the purpose of combating anxiety. A 
pathological distortion of this is the flight of the compulsive character from all 
emotion to the shadowy world of words and concepts (see p. 295). The lofty ii> 
tellectual interests that make their appearance at puberty also serve to master the 
instinctual excitement of that period (541). 

The achievement of the faculty of speech is 'experienced as the acquisition of 
a great power. It turns the “omnipotence of thought*' into an “omnipotence of 
words” (457). The child's earliest speech is a charm directed toward forcing the 
external world and fate to do those things that have been conjured up in words. 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 47 

Certain words retain their original magical power, for example obscene words 
(451), oaths, solemn formulae, or poetry. 

Thinking itself is a further elaboration and differentiation of the more 
primitive types of judgment which distinguished between what can be swal- 
lowed and what is better spit out, and, subsequently, between harmless and 
dangerous things; reaction, again, is postponed, and this postponement occurs by 
means of trial acting; the movements necessary for the planned action are done 
on a small scale, by which what is planned and its consequences are “tasted.” 
Muscular actions accompanying thinking have been demonstrated by experi- 
mental psychology (482, 776) . 

The working principle of the ego generally consists in a retardation of auto- 
matic id functions which provides the possibility of using these functions pur- 
posefully and in an organized way. In the same way that primary anxiety later 
is “tamed” and reduced to an “anxiety signal,” so does the ego in the process of 
thinking tame two archaic automatic reactions: the drive to discharge tensions, 
which is slowed down, and the tendency to hallucinatory wish fulfillment, which 
is reduced to the imagination of the prospective events and subsequently of the 
abstract symbols of these events, 

Just as the taming of anxiety may fail and the signal may start a recurrence of 
the primary panic, the tendencies to discharge at all costs and the hallucinatory 
wish fulfillment may come back in thinking. If persons are tired, asleep, intoxi- 
cated or psychotic, they think in another and more primitive way; and even in 
healthy, good thinkers who are wide-awake, every single thought runs through 
initial phases that have more similarity with dream thinking than with logic 
(1363). The characteristics of this prelogical emotional thinking have been in- 
vestigated in detail by both analytic and nonanalytic psychologists (1545, 1546, 
1547). It is less fitted for objective judgment as to what is going to happen 
because it is relatively unorganized, tolerates and condenses contradictions and is 
ruled by emotions and hence full of wishful or fearful misconceptions. This 
thinking according to the primary process seems to be directed only by the 
striving for discharge and is remote from any logic. But it is thinking neverthe- 
less, because it consists of imaginations according to which later actions are per- 
formed, and it is done with reduced energy. 1 % is carried out more through pic- 
torial, concrete images, whereas the secondary process is based more on words. 
The retranslation of words into pictures in dreams and in fatigue is well known, 
Preconscious pictorial thinking is a magical type of thinking (916, 1047). The 
object and the idea of the object, the object and a picture or model of the object, 
the object and a part of the object arc equated; similarities are not distinguished 
from identities; ego and nonego are not yet separated (1104). What happens to 
objects might (by identification) be experienced as happening to the ego, and 



48 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

what happens to the ego causes the same thing to happen to the object, a 
“transitivism” which makes the technique of “magical gestures” possible: by 
making a gesture someone forces another person to do the same thing. 

If a person feels ashamed, he looks away or covers his eyes with his hand; this 
means: “Nobody is to look at me.” Children believe that they cannot be seen if 
they cannot see. One child had the idea that when the conductor closes his eyes, 
the train passes through a tunnel. 

Another strange characteristic of archaic thinking is represented by symbolism. 
In adults a conscious idea may be used as a symbol for the purpose of hiding an ob- 
jectionable unconscious idea; the idea of a penis may be represented by a snake, an 
ape, a hat, an airplane, if the idea of penis is objectionable. The symbol is con- 
scious, the symbolized idea is unconscious. The distinct idea of a penis had been 
grasped but rejected. However, symbolic thinking is vague, directed by the 
primary process. It is not only a method of distortion; it is also a part of the primal 
prelogical thinking. Again, the censoring ego uses regressive methods. Again, 
when distorting through symbolism, the ego in its defensive activities makes 
use of mechanisms that previously operated automatically without any intent. 
The use of symbols is a falling back into an earlier primary stage of thinking, by 
means of which intended distortions are brought about. In dreams, symbols ap- 
pear in both aspects, as a tool of the dream censorship and also as a character- 
istic of archaic pictorial thinking, as a part of visualizing abstract thoughts (552, 
596), 

The regressive nature of symbolic distortions explains two facts: (a) that the 
symbols, being a residual of an archaic way of perceiving the world, are common 
to all human beings, like affective syndromes; (I?) that symbolic thinking occurs 
not only where distortions have to be made but also in states of fatigue, sleep, 
psychosis, and generally in early childhood, that is, in all states where archaic ego 
characteristics are in the foreground. 

Silberer explained symbolism as an “apperceptive insufficiency of the ego” 
(1427, 1428, 1429, 1430), He certainly was right, although his superficial classi- 
fication of symbols according to the cause of this insufficiency cannot be accepted, 
Jones is not convincing in his statement that retracing symbolism to insufficient 
apperception is like retracing slips of the tongue to fatigue (882). Slips of the 
tongue are not an essential part of the state of fatigue (they are only precipitated 
by this state), whereas it is an essential part of archaic thinking with insufficient 
apperception to experience the world in symbols. However, archaic symbolism 
as a part of prelogical thinking and distortion by means of representing a re- 
pressed idea through a conscious symbol are not the same. Whereas in distortion 
the idea of penis is avoided through disguising it by the ide^ of snake, in prelogi- 
cal thinking penis and snake are one and the same; that is, they are perceived by a 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 49 

common conception: the sight of the snake provokes penis emotions; and this 
fact is later utilized when the conscious idea of snake replaces the unconscious 
one of penis. 

Primitive symbolism is a part of the way in which conceptions are formed in 
prelogical thinking: comprehension of the world radiates from instinctual de- 
mands and fears, so that the first objects are possible means of gratification or 
possible threats; stimuli that provoke the same reactions are looked upon as 
identical; and the first ideas are not sums built up out of distinct elements but 
wholes comprehended in a still undifferentiated way, united by the emotional 
responses they have provoked. 

These characteristics suffice to explain some of the common symbols, namely, 
the symbols based on similarity, on pars pro toto or on identity of the provoked 
responses, such as tools = penis, shell = vagina, but also departure = death, rid- 
ing = sexual intercourse, king = father. In other cases the similarity of the pro- 
voked reactions is not obvious, but it can be found by an exact analysis of the 
child’s emotional experiences (z}6o). In this way the symbolic equation money = 
feces can be explained {see p. 281). However, in still other cases the connection 
between symbol and what is symbolized is not understood. The children who 
dream about spiders and mean cruel mothers (23) do not know anything about 
the spider’s sexual characteristics. Ferenezi believed that the disgust reaction 
toward reptiles contains a kind of phylogenetic memory (497) and Freud was 
inclined toward similar speculations in this respect (632). This question must 
remain open. 

The fact that the earliest thinking is not in accordance with reality but has 
all the archaic and magical features that have been described might be used as 
an objection to the statement that it, too, is ‘"preparation” and an attempt to 
master reality. But the inadequacy of this type of thinking does not contradict 
the fact that it is relatively more adequate than immediate discharge and wish- 
fulfilling hallucinations. 

However, this anticipation becomes incomparably more adequate through the 
development of words. The faculty of speech changes this prethinking into a 
logical, organized, and more adjusted thinking which follows the secondary 
process. Thus it is a decisive step toward the final differentiation of conscious 
and unconscious and toward the reality principle (575, 590). 

Yet even after speech, logic, and the reality principle have been established we 
find that prelogical thinking is still in operation and even beyond the role it 
plays in states of ego regression or as a form of purposeful distortion. It no 
longer fulfills, it is true, the function of preparing for future actions but becomes, 
rather, a substitute for unpleasant reality. 

The first ideas of objects came into being when a remembered gratification was 
missing. The first ideas about objects were both a substitute for the missing real 



5^ THE PSYCHOANALYTIC THEORY OF NEUROSIS 

object and attempts to master the real object magically. Primitive thinking 
attempted to control the object in a magical way (which, at that time, was be- 
lieved to be real). The secondary type of thinking strives to control it in a real 
way. But when this real way fails, when reality is too unpleasant or one is unable 
to influence it, one regresses again to the magical method. In the older child and 
the adult, the two types of thinking have the two different functions of prepara- 
tion for reality (anticipation of what is probable) and of substitution for reality 
(anticipation of what is desirable). 

This co-ordination of types of thinking with different functions is valid in 
general only. Practically there are certain ways of returning from daydreaming 
to reality (art) as well as of using word thinking for withdrawal from reality 
(compulsive thinking). 

/ As long as thinking is not followed by action it is called fantasy. There are 
two types of fantasy: creative fantasy, which prepares some later action, and 
daydreaming fantasy, the refuge for wishes that cannot be fulfilled. The former, 
rooted in the unconscious, certainly also starts in the primary process and imag- 
ination, but develops out of this sphere. The latter becomes a real substitute 
for action in the state of “introversion,” when the “small” movements accom- 
panying fantasy become intense enough to bring discharge. The problem has 
been discussed whether military games in boyhood increase or decrease bel- 
ligerent tendencies. Does fantasy stimulate the wish so that the tendency to 
realize fantasied ideas increases, or does fantasy channelize the wish so that 
what has been satisfied in games no longer needs to be satisfied in earnest } The 
answer becomes obvious in the case of sexual fantasies. If a man merely antici- 
pates in fantasy prospective sexual intercourse, his tension and his longing for 
fulfillment increase; but if his fantasies stimulate him to masturbation, the ten- 
sion decreases or vanishes. A preparatory fantasy has regressed to the substi- 

: tute type. 

. Neurotics are persons whose real actions are blocked. There arc two ways of 
expressing this blocking which demonstrate very well the contrast between 
magical pictorial daydreaming and abstract preparatory thinking. The hysterical 
type regresses from action to un worded daydreaming; his conversion symptoms 
are substitutes for actions. The compulsive type regresses from action to the prepa- 
ration for action through words; his thinking is a kind of eternal preparation for 
actions that never are performed. 

It might perhaps be expected that one remains in direct contact with reality as 
long as one’s thinking remains concrete, but that thinking ceases to serve as a 
preparation for real actions when it becomes too abstract, when it operates with 
sophistry and classification rather than with symbols for objects. This is true, but 
only to a certain degree. The pictorial nature of the elements of certain *‘con- 
crctc” thoughts may start daydreams instead of preparatory thinking. 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 


51 


Logical thinking presupposes a strong ego that is capable of postponements, 
tolerant of tensions, rich in countercathexes, and ready to judge reality accord- 
ing to its experience. If the ego is weak or tired or asleep or without confidence 
in its own ability and desirous of a receptive type of mastery, then the pictorial 
type of thinking becomes more attractive than objective intelligence. It is under- 
standable that tired persons prefer the movies to Shakespeare and an illustrated 
magazine to difficult reading, that dissatisfied persons without any possibility 
of actively influencing their situation ask for more illustrations in newspapers 
or for comic strips rather than for difficult intellectual pursuits. Whenever reality 
becomes unpleasant, more pictorial daydream substitutes are sought. 


DEFENSES AGAINST IMPULSES 

Up to now the reality principle appeared as the ability to postpone the final 
reaction. But certain reactions not only have to be postponed but even curtailed 
more or less permanently. Simultaneously with the increasing mastery of motil- 
ity — that is, with the change of mere discharge movements into actions — a non- 
discharge apparatus, a defense apparatus, also is developed. The ego learns to 
ward off impulses that are either dangerous or inappropriate. Mechanisms that 
first were used against painful external stimuli now become turned against 
inner drives. 

The ego wants to be satisfied. It seems paradoxical that it frequently turns 
against its own instinctual demands. Causes that bring about such a paradox 
have already been mentioned. They are: 

1. The biological fact that the infant is not able to control his motor apparatus 
and that he therefore requires external help to satisfy his instinctual demands 
leads to the consequence that he slips into traumatic situations, since the outside 
world cannot always immediately be at hand. The temporary disappearance of 
primary objects has in itself a traumatic effect because the child’s tender long- 
ings become deprived of their possibility of discharge. The memory of painful 
experiences of this kind leads to the first impression that instinctual excitations 
may be a source of danger. 

2 . Threats and prohibitions from the external world create fear of instinctual 
acts and their consequences. Such external influences may be of two somewhat 
different types: (a) objective and natural ones— the fire will burn the child who 
instinctively grasps at it — or {b) the dangers may be artificially pr(5duced by 
educational measures. Voluntarily or involuntarily, adults give children the im- 
pression that instinctual behavior is to be decried and that abstinence is praise- 
worthy. The effectiveness of these impressions is due not only to the adult’s real 
physical power but also to the dependency of the child’s self-esteem upon getting 
affection. 



52 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


3, The dangers feared may be entirely fantastic, in so far as the world is 
“projectively misunderstood” by the child. The violent force of his own repressed 
impulses is projected and makes him expect drastic punishments; the expected 
punishment is a retaliatory damage to the “sinful” parts of the body. 

4. Later on a fourth factor conies into being through the ego’s dependence 
on the superego, which is an intrapsychic representative of the objective, educa- 
tional, and projectively misunderstood external world. This fourth factor turns 
anxiety into guilt feeling. 

This systematic outline gives an answer to the problem of how forces that are 
hostile to the discharge of instinctual impulses originate. 


FURTHER REMARKS ABOUT ADAPTATION AND REALITY SENSE 

It is true that psychoanalysis has studied the defensive aspect of the ego more 
thoroughly than the development of its positive forces of adaptation (762). How- 
ever, the ideas of defense and of adaptation are interwoven. Adaptation in a dy- 
namic sense means finding common solutions for the tasks represented by inner 
impulses and outer (inhibiting and threatening) stimuli. 

Hartmann, in a very interesting paper, tried to show that adaptation has been 
studied by psychoanalysts too much from the point of view of mental conflicts. 
He points out that there is also a “sphere without conflict,” originating, it is 
true, in antitheses between organism and environment (750). 

Because of the importance of these antitheses, the term sphere without con- 
flict seems misleading, as tending toward an undynamic point of view. The ego’s 
maturation is a result of the continuous interplay of the organism’s needs and 
the environmental influences. Certainly the active types of mastery are rather 
complicated processes, many details of which still have to be investigated; but 
in the main it is understood how perception and motility are developed in con- 
nection with instinctual needs and with the functions of judgment and thinking 
(1176). 

A field where the study of adaptation is especially fruitful is the psychology of 
'will or desire. Biological needs are molded and modified through evaluations of 
the ego (or by influence of the superego); and just how these modifications 
occur, how subjective values are created by the influence of systems of values 
handed down by tradition, is one of the points clarified by individual psycho- 
analyses. 

Constitutional factors as well as experience determine how far the develop- 
ment of the sense of reality succeeds, how far the primal, vague, magical, 
fear-ridden world based on projections and introjections becomes an objec- 
tively judged ‘Teal” world, responded to by the individuars alloplastic forces 
and uninfluenced by hopes and fears, and how far the old forms persist. It never 



EARLY MENTAL DEVELOPMENT: THE ARCHAIC EGO 53 

succeeds entirely. Objective reality is differently experienced by different in- 
dividuals. Laforgue had this in mind when talking about the relativity of reality 
(1003, 1004). In neurotics all the misjudgings of reality and all the inability to 
differential learning (which cguse outer events to be experienced as repetitions 
of a few patterns only and which are characteristic for the archaic ego) make 
their appearance again. 

Behind all active types of mastery of external and internal tasks, a readiness 
remains to fall back to passive-receptive types of mastery; this readiness has a 
very different intensity in various individuals as well as under various cultural 
conditions. 

The sociological significance of the types of mastery that are encouraged or 
discouraged by various historically determined institutions was stressed by 
Kardiner in his promising earlier writings (918, 919, 920). Later, however, he 
felt that the social determination of the predominance of certain ego types in 
given cultures was incompatible with Freud’s ideas about instincts (921). 

The development of the ego and of the id does not occur separately but is 
interwoven, the one influencing the other. But before describing the develop- 
ment of the id, two concepts of fundamental importance to the psychology of the 
neuroses must be discussed: fixation and regression. 

In mental development, earlier levels still persist along with or underneath 
higher levels. Constitutional or experiential factors may cause this to become 
more transparent. In ego fixations or ego regressions an earlier level of ego 
development persists or returns, which may mean various things. It may refer 
to isolated ego functions which retain or again take on certain features of a 
more primitive phase. In this sense the eidetic types may be designated as per- 
ception fixations. Thinking may have retained a more magical character than 
in normal persons, as in compulsion neurotics, where early overdeveloped intel- 
lect is to be seen simultaneously with superstition and with unconscious belief in 
omnipotence and in the law of retaliation. The relationships to objects may 
show primitive features. There may be fixations at the earlier love levels, with 
aims of incorporation, or at the types of self-esteem regulation characteristic of 
small children. Finally the ego fixation may limit itself to a repetitious use of 
specific types of defense (429) {see pp. 5231!.). 



Chapter V 

EARLY MENTAL DEVELOPMENT (CONTINUED): 
DEVELOPMENT OF INSTINCTS, INFANTILE 
SEXUALITY 

WHAT ARE INSTINCTS? 

Freud suggested that two kinds of excitation should be distinguished : one that is 
evoked by external, perceptual, discontinuous stimuli and another that arises 
from continuous instinctual stimuli within the organism (971)* 

This statement, however, deserves more detailed consideration. All percep- 
tions, all sensory stimuli, whether they originate without or within the or- 
ganism, have a “provocative character,” provoke a certain urge to action. In 
the archaic types of perception this connection with motility, as has been 
pointed out, is more distinct than it is later. The intensity of the urge varies with 
the variable physical states of the body. Food has a variable meaning for the 
individual, depending on whether he is hungry or satiated; this also holds true 
for sexual stimuli. Only the physical conditions that determine the urge, the 
chemistry of the body, and not the sensory stimuli can rightly be called the 
sources of instincts. A certain impulse to action arises from every perception, 
whether it be internal or external. Under specific somatic conditions these im- 
pulses take on the character of urgent instinctual drives (1023, 1024). 

At first glance one finds many contradictory presentations of the essence of the 
instincts both in Freud’s writings and in psychoanalytic literature in general. 
First, instinct is explained as “the measure of the demand made upon the mind 
in consequence of its connection with the body” (588) ; an urgent state of ten- 
sion, caused chemically and manifested through a sensory stimulus, is to be dis- 
charged. This concept is very illuminating since it is consonant with the reflex 
pattern as the basis for all mental functions, and it is clearly this concept of in- 
stincts that has enabled psychoanalysis to rest on a biological basis (555) . In the 
same passage, Freud calls instinct “a borderline concept between the mental and 
the physical” (588) ; phenomena of instincts can be considered from the physical 
aspect by examining the source of instinct, or they can be considered from the 
mental aspect by examining the drive and the resultant psychological phenomena. 
At another place, instincts arc called “mystical forces” whose mode of operation 
we investigate without knowing anything about their existence (628)- That 
sounds strange since psychoanalysis tries to eliminate everything mystical. What 
is meant is that vye are aware of the experience of instinctual impulses and actions 
but never of “the instinct.” What constitutes the unity of “one instinct” is highly 
debatable. The definition will vary according to the classification applied, that is. 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 55 

according to whether aim, object, or source is made the main criterion. It is there- 
fore necessary to define these concepts. 

The aim of an instinct is its satisfaction or, more precisely, the very specific 
discharge action which dispels the physical condition of excitement and thus 
brings about satisfaction. The oh\cct of an instinct is that instrument by which or 
through which the instinct can attain its aim. The source of an instinct is the 
chemicophysical status which causes a sensory stimulus to bring about excite- 
ment (588). What instincts are to be distinguished and how many depends on 
whether the aim, the object, or the source is chosen as the basis of classification. 
In terms of aim or object an infinite number of instincts might be described. 
However, psychoanalysts know how readily interchangeable objects and aims 
can be. (This very fact makes it paradoxical to attribute to Freud the opinion 
that “instincts” represent entirely unchanging rigid patterns [1105].) Thus a 
classification according to source would be the preferable one. Unfortunately, 
physiology here disappoints us; the instinctual sources are a purely physiological 
problem, and in this field our knowledge is not yet sufficient. In spite of this de- 
ficiency two categories of instincts arc definitely discernible. 

The first category is represented by certain simple physical needs which, inci- 
dentally, present the best model for the course of an instinct: somatic changes 
cause certain urgent sensory experiences; the urge precipitates a specific action 
which eliminates the somatic change and relaxation is felt. The character of 
drive becomes especially apparent when the normal course is hindered. Exam- 
ples are breathing, hunger, thirst, defecation, urination. Since the satisfaction 
of these urges is vital, the actions can be postponed for a short time only and 
their aims cannot be altered. Consequently there is hardly any variability in these 
needs and for psychology they arc of relatively minor importance. The assump- 
tion that it is the lowering of the excitation level— relaxation— that is experienced 
by the ego as pleasure can be easily verified with these instincts. 

Recognition of the second group as a cohesive unit was made possible only by 
psychoanalytic research (555)* This is the group of the sexual instincts. In contra- 
distinction to the imperative instincts discussed above, the sexual instincts, if 
they cannot find gratification in their original form, have the capacity to change, 
to alter their objects or aims, or to submit to repression by the ego and then to 
make themselves apparent again in various ways and in different disguises. 
The widely circulated reproach is still heard that Freud explains everything as 
sexual. This is far from correct, for Freud recognizes other instincts besides sex- 
ual ones. But it is true that Freud explains as sexual many phenomena which 
had previously not been recognized as having any connection with sexuality- 
in particular, the neuroses. He recognizes that human sexuality is by no means 
limited to the impulses and actions that lead more or less directly to sexual intcr- 
couisc. He recognises the field of infantile sexuality (550, 551, 552, 555). 



56 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


It is generally known today that children exhibit numerous types of instinctual 
bcha'vior which in content are identical with the drives which in perverse indi- 
viduals replace normal sexuality. Indeed, it is difficult to observe children with- 
out seeing manifestations of this kind. Consequently, today it seems less appro- 
priate to phrase the question: “Is there an infantile sexuality?’' than to ask: 
“How was it possible that so obvious a phenomenon as infantile sexuality was 
not observed before Freud?” This striking oversight is one of the best examples 
of “repression.” 

Why does Freud call these infantile phenomena sexual? First, because they 
constitute the native soil from which the sexuality of the adult subsequently 
develops; second, because every adult who is in any way blocked in his sexual- 
ity falls back to infantile sexuality as a substitute; third, because the child 
experiences his sexuality with the same emotions the adult feels toward his; 
fourth, because the aims of these strivings are identical with the aims observable 
in adult perversions, and no one has ever doubted that the perversions are any- 
thing but sexual. 

It is probable that the sexual instincts have a common chemistry as their basis. 
The study of the hormones has taught us some things about the sources of sexual- 
ity, but present knowledge is far from sufficient. Chemical changes in the body in- 
itiate sensory stimuli in the erogenous zones, bringing forth impulses of a particu- 
larly urgent character, demanding actions that lead to changes at the place of 
stimulation. The physiological basis of sexual impulses is comparable to the 
physiological occurrences that arouse sensations such as itching or tickling. In- 
sect bites or internal physiological conditions produce chemical changes causing 
sensory stimuli in the skin which, in turn, create feelings of an especially urgent 
kind; the impulse to scratch is aroused and scratching finally leads to a change 
at the source. 

However, although scratching may be effective through changing the blood 
supply to the itching area, one gets the impression that scratching represents a 
remainder of a much deeper biological reflex which is also of basic importance for 
sexual discharges: th6 reflex to get rid of organs that create disturbing sensations. 
The autotomy of lizards’ tails shows this biological tendency to its full extent. 
Later this reflex may degenerate to the idea to “scratch away” an itching area of 
skin, and probably also to the idea of the “detumescing” discharge in sexual ten- 
sion (124a). An evaluation of the concept of autotomy shows the relativity of the 
contrast between satisfaction of an instinct and defense against an instinct; the 
autotomic reflex may be a common root for both the instinctive act and the de- 
fense against the instinctive act. 

Subsequently sexual phenomena become much more complicated, but in the 
last anialysis they remain within the same frame of operational mechanisms. 
During puberty, the various' impulses of infantile sexuality fuse into a harmo- 
nious whole— the sexuality of the adult. But this development may undergo a 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 57 

variety of disturbances. Anxieties and other experiences of the child may cause 
single components to resist the fusion. In particular, the repressed components 
of infantile sexuality continue to exist in the unconscious, unchanged. When the 
adult person later experiences a sexual disappointment, he tends to fall back to 
infantile sexuality. The result is that the conflicts that raged about his sexuality 
in childhood likewise become mobilized again. 


CLASSIFICATION OF INSTINCTS 

The exceptional role that the displaceability of energy gives to the sexual in- 
stincts was the starting point for Freud’s first classification of instincts. He found 
that neurotics fell ill because of their repression of certain experiences, and that 
these experiences were always representatives of sexual wishes. The forces fight- 
ing the sexual wishes were anxieties, guilt feelings, or ethical and esthetic ideals 
of the personality; these countersexual forces could be summarized as “ego in- 
stincts,” since they serve the purpose of self-preservation. Thus the first classi- 
fication of instincts, distinguishing “sexual instincts” from “ego instincts” (542, 
54^? 555) 5^5) 59^) » supposed to represent the neurotic conflict, that is, the 
fact of repression. When Jung denied this dualism of instincts and wanted to 
call all ego instincts libidinal (907), his unification at that time would have 
obscured the newly discovered fact of repression (364) . 

Today repression is not conceived of as a conflict between two groups of in- 
stincts; the conflict is rather a structural one. The ego wards off certain demands 
of the id. And from the concept that the ego is a differentiated surface layer of 
the id, it is no longer tenable to expect the ego to harbor innately other instincts 
than are present in the id. Even if the instinctual energies in the ego are treated 
otherwise than in the id, it must be assumed that the ego derives its energy from 
the id and contains primarily no other kinds of instincts. 

The criticism of the first classification of instincts originated in the discovery 
of narcissism, that Is, of the libidinal character of some instinctual wishes, which 
until then had been attributed to the ego instincts. Part of the “egoism,” of the 
high evaluation of one’s own ego, turned out to be of the same nature as the 
sexual instincts with which objects arc loved; this becomes manifest in the dis- 
placeability of the energy of the ego to objects and vice versa. The sum of interest 
turned toward one’s ego and to outside objects is, for a given time, constant. 
He who loves himself more is less interested in outside objects and vice 
versa (585). Freud compared man in respect to libido with an amoeba that 
can stretch out pscudopodia, originally concentrated within its own body sub- 
stance, toward iie outside world, and then can draw them back again (585). 
Accordingly the designations ego libido and object libido are applied^. However, 
there is no difference in quality between the two; by a mere displacement proc- 



)8 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


iss, ego libido changes into object libido and vice versa. With these findings the 
:ornier division of instincts into ego instincts and sexual instincts has become 
inadequate. The fact that this division reflected the facts of repression led at first 
to an attempt to preserve it. Freud undertook this on the assumption that the 
ego instincts were cathected with two different qualities of psychic energy: with 
“interest,” corresponding to the energy of the ego instincts, and with libidinal 
elements, which constitute narcissism (585). Such a conception could not be 
naaintained. After the recognition of displaceable libidinal elements, the view 
could no longer be accepted that in the repressing and in the repressed (or, in 
today’s terminology, in the ego and in the id) there are two fundamentally dif- 
ferent kinds of instincts at work. Both ego interests and libidinal drives, which 
later certainly are often in conflict with each other, have evolved from a common 
source, 

Freud then proposed his new classification of instincts (605, 608). This new 
classification has two bases, one speculative and one clinical. The speculative basis 
is the conservative character of the instincts, as characterized by the constancy 
principle, namely, the fact that instincts tend toward getting rid of tensions. But 
there is also a phenomenon that seems to run contrary to the constancy principle, 
namely, a hunger for stimuli, seen most distinctly in the sexual instincts. Thus it 
seems as if the “Nirvana principle” characterizes some instincts and the hunger 
for stimuli others. 

The clinical basis of the new Freudian theory is the existence of aggression. 
Aggressive tendencies of all kinds constitute a considerable proportion of all 
human drives. In part they manifest a reactive character; that is, they are the 
response to frustrations and have as their goal the overcoming of frustrations 
(335) • they appear closely connected with certain sexual drives, especially 
with sexual drives that are prominent in pregcnital levels of libido organization. 
Other agressions seem to arise quite apart from sexuality. Besides, there is the 
riddle of masochism, the fact that under certain circumstances our usual orienta-i 
tion in human behavior, the pleasure principle, seems to be put out of action, and 
self-destructive tendencies come to the fore. Further, clinically, masochism and 
sadism always are bound together: wherever masochism is found, analysis shows 
that a sadistic drive has undergone a “turning against the ego” (555, 601), The 
opposite also exists: an external sadistic type of behavior may veil an unconscious 
masochistic aim. 

Ereud combined the speculative and the clinical bases into a new instinct 
theory (605) which states that there are two qualities in the mind : a self-destruc- 
tivc one, the “death instinct” (which can be turned toward the outside world and 
thus become a “destructive instinct”), and an object-seeking quality, striving 
for higher units, the eros. The objection that in reality there is neither a pure self- 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 59 

destructive nor a pure object-seeking behavior is overcome by assuming that the 
real mental phenomena are composed of various “mixtures” of these qualities 
(138, 144, 890, 900, 1014). 


CRITICISMS OF THE CONCEPT OF A DEATH INSTINCT 

There are many possible objections to this new theory (425). Here the follow- 
ing may suffice. The instinctual aim of destruction is the opposite of the sexual 
search for an object to be loved; of this there is no doubt. Questionable, however, 
is the nature of this antithesis. Are we dealing with basically difierent instinctual 
qualities or is this contrast again a matter of differentiation of an originally com- 
mon root .i’ The latter seems more probable. One could group all the phenomena 
collected under the heading of death instinct not as a special type of instinct but 
as expressions of a principle, valid for all instincts; in the course of development 
this principle might have been modified for certain instincts by external influ- 
ences. The concept of the constancy principle, as a starting point for all instinas, 
allows for a unified thesis not only for all mental processes but for all living proc- 
esses in general as well. Just in that group of drives, the sexual instincts, where 
hunger for stimuli, search for objects, and striving for higher units becomes espe- 
cially clear, it is most demonstrable that they strive for relaxation and for getting 
rid of tensions. Hence it is not possible that for one kind of instinct the con- 
stancy principle is valid and for another kind stimulus hunger is valid. On the 
contrary, stimulus hunger as a principle contradicting the cdnstancy principle 
must be genetically a derivative of the constancy principle or a special elaboration 
of it. When the infent is awakened by somatically conditioned hunger, he follows 
his constancy principle and desires to quiet the hunger and to fall asleep again. 
When he later recognizes the external world as necessary for this achievement, 
he strives toward this necessity and asks for contact with this outside world. The 
goal of being stimulated by the external world is an intermediary one, a detour 
to the goal'of not being stimulated {see p.35). 

Of course, the existence and importance of aggressive drives cannot be denied. 
However, there is no proof that they always and necessarily came into being by 
a turning outward of more primary self-destructive drives. It seems rather as if 
aggressiveness were originally no instinctual aim of its own, characterizing one 
category of instincts in contradistinction to others, but rather a mode in which 
instinctual aims sometimes are striven for, in response to frustrations or even 
spontaneously. 

Aims arc sought more readily in a destructive way the more primitive the 
mani r aricin kvcl of the organism— pcrhaps in connection with the insufficiently 
developed tolerance toward tensions. The archaic instinctual aim toward objects 



6o 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


is incorporation, which is as much an attempt to achieve closeness as an attempt 
to destroy the object. It is the matrix of both. Freud describes this proneness to 
destructiveness on the archaic levels by saying that death instinct and eros are 
still “defused>” while they fuse gradually during maturation, eros neutralizing 
death instinct (608). The facts are that in these early periods libidinal and 
aggressive tendencies are so interwoven that they never can be entirely separated 
from each other; it seems as if these stages represent an integrated state, from 
which, later, eros and aggression are differentiated; only later do love and hate 
develop as opposite qualities. 

Likewise a death instinct would not be compatible with the approved biologi- 
cal concept of instinct as discussed above. The thesis of an instinct source that 
makes the organism react to stimuli with drives toward ‘'instinct actions,” which 
then change the source in an appropriate manner, cannot be applied to a death 
instinct. The dissimulation in the cells, an objective destruction, cannot be a 
“source” of a destructive instinct in the same way that the chemical sensitizing of 
the central nervous system in regard to stimulation of the erogenous zones is the 
source of the sexual instinct. According to the definition, the instinct attempts 
to remove the somatic changes at the source of the instinct. The death instinct 
does not attempt to remove the dissimulation. 

It seems, therefore, as if the facts on which Freud based his concept of a death 
instinct in no way necessitate the assumption of two basically opposite kinds of 
instincts, the aim of one being relaxation and death, the aim of the other being a 
binding to higher units. In the chapters on masochism and depression an attempt 
will be made to show that the clinical facts of self-destruction likewise do not 
necessitate the assumption of a genuine self-destructive instinct and that all 
occurrences beyond the pleasure principle can be looked upon as created by 
external forces that disturbed the principles innate to the organism {sec pp. 358 ff. 
and 387 if.). 

The idea that the concept of a death instinct is neither necessary nor useful 
does not refute possible speculations that life might be looked upon as a “process 
leading to death.” The young organism embodies an abundance of prospective 
potentialities. Every moment of life that is lived through produces “structure” 
which limits the prospective potentialities, makes the organism more rigid, and 
brings it nearer to the inorganic. Whoever accepts this point of view may sec in 
the mental functions once again a special case of the process of life in general. 

We may summarize. Unquestionably there are often conflicts between the 
ego’s interests and its sexual drives; there are quite as often conflicts between 
aggressiveness and sexual tendencies. However, both kinds of conflicts have a 
history; they came into being at a certain, point of development and remain 
conflicts only as long as certain conditions prevail, There is no necessity to 
assume that either of these two pairs of opposites represents a genuine and un- 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 

conditioned dichotomy, operative from the very beginning. For a better classi- 
fication of instincts, we shall have to wait until physiology develops more valua- 
ble theses about instinctual sources. 


INFANTILE SEXUALITY 

If we turn now to the study of the development of sexuality we are able to 
leave speculation and return to an empirical basis. 

The characteristics of the polymorphous perverse infantile sexuality arc well 
known from Freud’s Three Contributions to the Theory of Sex (555). Infantile 
sexuality differs from adult sexuality in several respects. The most impressive dif- 
ference lies in the fact that the highest excitation is not necessarily located at the 
genitals, but that the genitals, rather, play the part of primus inter pares among 
many erogenous zones. The aims, too, arc different; they do not necessarily lead 
toward sexual intercourse but linger at activities that later play a role in forcplcas- 
ure. Infantile sexuality may be autoeroiie, that is, take the child’s own body or 
parts of it as its object. The components, which are directed toward objects, 
bear archaic features (incorporation aims and ambivalence). When a partial 
instinct is blocked, “collateral” partial instincts become correspondingly strength- 
ened. 

The small child is an instinctual creature full of polymorphous perverse sexual 
drives or, to put it more correctly, full of a still undifferentiated total sexuality 
which contains all the later ‘‘partial instincts” in one. Reality seems to be judged 
'at first only as to whether it is compatible with instinct satisfaction. Reality, as 
conceived of by the primitive ego, is colored by the status of its sexual aims. 
Every kind of excitation in the child can become a source of sexual excitement: 
mechanical and muscular stimuli, affects, intellectual activity, and even pain. In 
infantile sexuality excitement and satisfaction are not sharply differentiated al- 
though there arc already orgasmlikc phenomena, that is, pleasureful sensations 
that bring relaxation and the end of sexual excitation. In time, however, the 
genitals begin to function as a special discharge apparatus, which concentrates all 
excitation upon itself and discharges it no matter in which erogenous zone it 
originated. 

It is called genital primacy when this function of the genitals has become 
dominant over the extragenital erogenous zones, and all sexual excitations be- 
come finally gcnitally oriented and climactically discharged. The antithesis to 
genital primacy is the earlier prcgcnital period, when the genital apparatus has 
not yet assumed dominance, and as a result the relaxation achieved is never com- 
plete. The road from the early prcgcnital strivings to genital primacy can be 
described from two different points of view; from that of the change of the leadr 
ing erogenous zones, and from that of the types of object relationships- 



62 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


First of all it must be emphasized that the concept of developmental phases is 
a relative one, serving as a better means of orientation only. Practically, all phases 
gradually pass into one another and overlap. 

When one attempts to organize the abundance of phenomena in infantile 
sexuality, one is struck by a period in which these phenomena arc relatively few 
and the number and intensity of direct sexual manifestations are diminished. 
This is the so-called period of latency, extending from the sixth or seventh year 
of life until puberty. It is true that sexual manifestations never completely dis- 
appear; cultures have been described in which a period of latency seems to be lack- 
ing, and even in our culture there are many children who do not renounce their 
masturbation during these years; but even in these cases, sex is less in the fore- 
ground than it is earlier and later. Freud was of the opinion that the occurrence 
of the period of latency is a characteristic of the human species. The early blossom- 
ing of infantile sexuality is, as it were, “doomed to destruction” by nature, and this 
fact is a biological precondition for repression and thus for neuroses (6i8) . Other 
authors have pointed out that since among some primitive tribes a latency period 
never appears, cultural restrictions must be responsible for the renunciation of 
sexual wishes (no2, 1278). However, there is no clear-cut contradiction between 
“biologically” and “socially” determined phenomena. Biological changes may 
be brought about by former external influences. It may be that the latency period 
is a result of external influences that have been in effect long enough to have 
left permanent traces; perhaps at this point wc arc watching external influences 
becoming biological At any rate, during this period the forces operative against 
instinctive impulses, such as shame, disgust, and so forth, develop at the price of 
instinctual energies. 

Thus preadult sexuality generally can be divided into three major periods: the 
infantile period, the latency period, and puberty. The beginning and the end of 
the infantile period arc very well known today, whereas that which lies in be- 
tween is still in need of much research. It is possible that in this in-between stage 
accidental variations arc of greater import than they are in the beginning and 
end phases. 

THE ORAL STAGE 

The beginning is the oral (more correctly the intestinal) state of organization 
.of the libido (13, 555). In discussing the development of the ego, factors were 
brought out as to how the knowledge of reality comes about in connection with 
experiences of hunger and satiation. Further, it was evident that the first pcrccp- 
^ tions were connected with a kind of oral incorporation, and that the first judg- 
ing was the decision whether or not a substance was edible. These findings may 
now be supplemented by a discussion of the autocrotic phenomenon of thumb- 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITT 63 

sucking. Thumbsucking is already evident in the newborn child and can, of 
course, be considered an innate reflex. That does not prevent us from noting that 
this reflex is concerned with a type of stimulation that usually is tied up with the 
function of nourishment but has become independent of it. Thumbsucking 
shows that the pleasure gained from breast or bottle is based not alone on the 
gratification of hunger but on the stimulation of the erogenous oral mucous 
membrane as well; otherwise the infant would disappointedly remove his 
thumb, since it produces no milk. There, sexual excitement has originally leaned 
upon the need for nourishment; in a similar way early sexual excitement has 
also leaned upon other physiological functions, upon breathing and cutaneous 
sensations and upon the sensations of defecation and urination. 

It is not necessary to go into detail here about the many phenomena in which 
oral eroticism is still retained in the adult : kissing, perverse practices, drinking 
and smoking customs and many eating habits. One must not forget, however, 
that in drinking and smoking we are not dealing only with oral eroticism. 
Alcohol and nicotine are also toxins, which by chemical means produce wished- 
for changes in the balance of instinctual conflicts. These changes diminish inhibi- 
tions, heighten self-esteem, and ward off anxiety, at least for a short time and 
to a certain extent. 

The aim of oral eroticism is first the pleasurable autocrotic stimulation of the 
erogenous zone and later the incorporation of objects. Animal crackers, loved 
by children, are significant remnants of early cannibalistic fantasies (165). The 
appearance of an especially intense greed, cither manifest or, after its repression, 
in the form of derivatives, is always traceable to oral eroticism. Many peculiarities 
of persons fixated at this level can be explained by realizing that in this period 
objects arc not looked upon as individuals but only as food or providers of food. 
By incorporating objects one becomes united with them. The “oral introjection” 
is simultaneously the executive of the “primary identification.” The ideas of eat- 
ing an object or of being eaten by an object remain the ways in which any re- 
union with objects is thought of unconsciously. The magical communion of 
“becoming the same substance,” cither by eating the same food or by mixing the 
respective bloods, and the magical belief that a person becomes similar to the 
object he has eaten are based on this fact. Abundant evidence of this is to be 
found in experiences ranging from religious rites to everyday habits. Hand- 
shaking means that union is sealed by letting one’s body substance flow into 
the other person’s. And a companion is still a “com-panion,” a person whose 
bread is identical with ours. 

Corresponding to the specific aims of oral eroticism and in accordance with the 
principle of animistic misunderstanding, we fiuid specific oral fears, especially 
the fear of being eaten (414, 618). 



64 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


Analytic experience shows that the fear of being eaten often serves as a cover 
for a more deeply hidden castration anxiety (566, 599). This is not to be taken as 
an objection to the archaic nature of this fear. The distortion, which aids in the 
defense against castration anxiety, may operate through regression. 

Of course, the idea of being eaten is not only a source of fear but under cer- 
tain circumstances may also be a source of oral pleasure. There is not only a 
longing to incorporate objects but also a longing to be incorporated by a larger 
object. Very often, the seemingly contradictory aims of eating and of being 
eaten appear condensed with each other. In the chapter on the ego the longing 
to be rejoined with an object to which one had yielded one’s omnipotence was 
described. This rejoining, too, is unconsciously thought of as a kind of being 
eaten by a larger, more powerful object; it depends on individual circumstances 
whether this idea is met with positive longing or with anxiety (712). 

Clinical experience shows that aims of oral incorporation often assume a 
sadistic character. This probably occurs under the influence of unknown con- 
stitutional factors or as a reaction to frustrations. Psychoanalysis of persons suf- 
fering from depressions or addictions shows that actually the sadistic character 
of the incorporation fantasies did not become added on later but was actually 
operative at the time of the oral phase. However, that is certainly no reason for 
assuming that every infant sucking at his mother’s breast has the desire to kill 
and destroy her in a sadistic manner. The clinical material of British analysts 
who hold this point of view (958, 959, 1309) certainly should not be doubted. 
What is doubtful, however, is that the cases described are typical; they repre- 
sent, rather, pathological cases with special oral-sadistic fixations (99, 429). 

However, incorporation destroys the object objectively. This fact gives all the 
aims of incorporation a more or less “ambivalent” character. It has already been 
stated that this ambivalence does not exist from the very beginning. As long as 
there is no conception of objects, it is meaningless to talk about ambivalence. 
However, as soon as a conception of objects is developed, the objectively de- 
structive character of the incorporation facilitates a connection of ideas of incor- 
poration with sadism, especially if definite frustrations have been endured (26). 

The oral-sadistic fantasies, reconstructed in the analysis of orally fixated pa- 
tients {cf, 104) and sometimes manifest in orally oriented psychoses, are so fan- 
tastic that certain authors arc even of the opinion that real experiences are not at 
all important for their formation (1312). Actually, however, these “fantasies” ex- 
press the ways in which an undeveloped archaic ego perceives (and misunder- 
stands) a frustrating reality, 

Abraham difierentiated two subphascs of the oral stage: a prcambivalent one 
in which subjectively no object exists and only pleasurable sucking is sought, 
and an ^ambivalent phase, appearing after the eruption of teeth, which has the 
aim of biting the object (26). Analysis of sadistic perverts often reveals that at 



DEVELOPMENt OE mSTINCTS, INFANTILE SEXUALITY ^5 

the bottom of their symptoms there is a fixation on the oral sexual aim of biting 
(1205). This co-ordination of sucking and the phase before the establishment 
of objects, and of biting and oral-sadistic drives, does not entirely fit, however; 
often oral-sadistic sucking fantasies directed against objects can be observed 
(vampire). 

Of the neuroses, the manic-depressive cycle and the addictions present mani- 
festations of fixation on the oral level. However, since in mental development 
earlier developmental levels still persist behind the more mature ones, oral- 
erotic characteristics are also present in all other neuroses. 

Because of their significance for the later development of neuroses, it is ad- 
visable to elaborate again upon the concepts of fixation and regression which 
were discussed in the chapter on the ego (see p. 53). It was stated that in mental 
development the progress to a higher level never takes place completely; instead 
characteristics of the earlier level persist alongside of or behind the new level to 
some extent. Disturbances of development may occur not only in the form of a 
total arresting of development but also in the form of retaining more characteris- 
tics of earlier stages than is normal. When a new development meets with dif- 
ficulties, there may be backward movements in which the development recedes 
to earlier stages that were more successfully experienced. Fixation and regression 
arc complementary to each other. Freud used the simile of an advancing army in 
enemy territory leaving occupation troops at all important points. The stronger 
the occupation troops left behind, the weaker is the army that marches' on. If 
the latter meets a too powerful enemy force, it may retreat to those points 
where it had previously left the strongest occupation troops (596). The stronger 
a fixation, the more easily will a regression take place if difBculties arise. 

What are the factors responsible for evoking fixations.? Unquestionably there 
are hereditary tendencies that account for the various erogenous zones being 
charged with different amounts of cathexis or different degrees of ability for 
discharge. Little is known about such constitutional factors. Psychoanalysis did 
succeed, however, in studying the kinds of experience that favor the development 
of fixations. 

1. The consequence of experiencing excessive satisfactions at a given level is 
that this level is renounced only with reluctance; if, later, misfortunes occur, 
there is always a yearning for the satisfaction formerly enjoyed. 

2. A similar effect is wrought by excessive frustrations at a given level. One 
gets the impression that at developmental levels that do not afford enough satis- 
faction, the organism refuses to go further, demanding the withheld satisfac- 
tions. If the frustration has led to repression, the drives in question are thus cut 
off from the rest of the personality; they do not participate in further maturation 
and send up their disturbing derivatives from the unconscious into the conscious. 
The result is that these drives remain in the unconscious unchanged, constantly 



66 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


demanding the same sort of satisfaction; thus they also constantly provoke the 
same defensive, attitudes on the part of the defending ego. This is one source of 
neurotic “repetitions” (see p. 542). 

3. One frequently finds that excessive satisfactions as well as excessive frustra- 
tions underlie a given fixation; previous ovcrindulgcnce had made the person 
unable to bear later frustrations; little frustrations, which a less spoiled individual 
could tolerate, then have the same effect that a severe frustration ordinarily has. 

4. It is understandable, therefore, that abrupt changes from excessive satisfac- 
tions to excessive frustrations have an especially fixating effect. 

5. Most frequently, however, fixations are rooted in experiences of instinctual 
satisfaction which simultaneously gave reassurance in the face of some anxiety 
or aided in repressing some other feared impulse. Such simultaneous satisfaction 
of drive and of security is the most common cause of fixations. 


THE ANAL-SADISTIC STAGE 

The analysis of compulsion neuroses enabled Freud to insert between the 
oral and phallic periods another organizational level of the libido, namely, the 
anal-sadistic level (581). Anal pleasure certainly is preSent from the beginning 
of life. However, in the second year of life the anal-erogenous zone seems to 
become the chief executive of all excitation which now, no matter where it 
originates, tends to be discharged through defecation. The primary aim of anal 
eroticism is certainly the enjoyment of pleasurable sensations in excretion. Later 
experience teaches that stimulation of the rectal mucosa may be increased by 
holding back the fecal mass. Anal-retention tendencies arc a good example of 
combinations of erogenous pleasure with security against anxiety. Fear of the 
originally pleasurable excretion may lead to retention and to the discovery of 
retention pleasure. The possibility of achieving a more intense stimulation of the 
mucous membrane, and with it a more intense sensation through the increased 
tension of retention, is responsible for the tension pleasure which is greater in 
anal eroticism than in any other eroticism. Persons who, in their pleasures, seek 
to prolong the foreplcasurc and to postpone the end pleasure arc latently always 
anal erotics. 

The origin and character of the connection between anal and sadistic drives, 
hinted at in the term for the organization level (anal sadism) , is analogous to 
the discussed connection between orality and sadism. It is due partly to frustrat- 
ing influences and partly to the character of the incorporation aims. However, 
two factors must be added. First, the fact that dimination objectively is as 
“destructive’* as incorporation; the object of first anal-sadistic action is the 
•feces themselves, their “pinching ofP! being perceived as a kind of sadistic act; 
later on, persons arc treated as the feces previously were treated. Second, tkc 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 67 

factor of “social power” involved in the mastery of the sphincters: in training for 
cleanliness, the child finds opportunity eifectively to express opposition against 
grownups. 

There are physiological reasons for the connection of anal eroticism to am- 
bivalence and bisexuality. Anal eroticism makes the child treat an object, namely 
feces, in a contradictory manner; he expels the matter from the body and retains 
it as if it were a loved object; this is the physiological root of “anal ambivalence.” 
On the other hand the rectum is an excretory hollow organ; as an excretory 
organ it can actively expel something; as a hollow organ it can Ke stimulated 
by an entering foreign body. Masculine tendencies are derived from the first 
faculty, feminine tendencies from the second; this is the physiological root of 
the connection between anal eroticism and bisexuality (846). 

The first anal strivings are, of course, autoerotic. Pleasurable elimination as 
well as (later) pleasurable retention can be attained without any object. The 
fact that this pleasure is experienced at a time when the primary feelings of 
omnipotence are still operative can be seen in the magical narcissistic over- 
valuation of the power of the individuaPs bowel movements; this finds expres- 
sion in many neurotic and superstitious remnants (19). Though the pleasure is 
attained by the stimulation of the rectal mucous membrane, the feces, as the 
instrument by which this pleasure is attained, also become a libidinal object. 
They represent a thing which first is one’s own body but which is transformed 
into an external object, the model of anything that may be lost; and thus they 
especially represent “possession,” that is, things that are external but nevertheless 
have ego equality. The impulse to coprophagia which certainly has an erogenous 
source (representing an attempt to stimulate the erogenous zone of the mouth 
with the same pleasurable substance that previously stimulated the erogenous 
zone of the rectum) simultaneously represents an attempt to re-establish the 
threatened narcissistic equilibrium; that which has been eliminated must be 
rcintrojectcd. A similar attempt at cutaneous reintrojection is represented by the 
impulse to smear (1050). Thus the feces become an ambivalendy loved object. 
They arc loved and held back or rcintrojectcd and played with, and they arc 
hated and pinched ofi. 

Certain anal pleasures are first perceived in the sensations accompanying the 
mother’s care when diapers arc changed. This care and, later on, conflicts aroused 
by the child’s training toward cleanliness gradually turn the autoerotic anal 
strivings into object strivings.. Then, objects may be treated exactly like feces. 
They may be retained or introjected (thcr.c are various types of anal incorpora- 
tion) as well as eliminated and pinched oflE (21, 26), The training for cleanliness | 
gives ample opportunity for sensual and hostile gratifications. The “narcissistic 
overvaluation” (19) expresses itself now in a feeling of power over the mother 
in giving or not giving the feces. Other anal tendencies directed at objects arc 



68 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


the impulses to share anal activities with somebody else: to defecate together, 
to watch and exhibit anal activities, to smear together, to defecate on another 
person or to have another person defecate on oneself. All these anal object striv- 
ings are ambivalently oriented. They may express tenderness in an archaic way, 
as well as, after their condemnation, hostility and contempt (“to play a dirty trick 
on somebody”) (463, 1074), 

Abraham took this contradictory attitude of the anal erotic toward the object 
world as a starting point for his suggestion to subdivide the phase of anal or- 
ganization of the libido into an earlier period having a sadistic aim in excretory 
pleasure without consideration for the object, and a later period characterized 
by a prevalent retention pleasure where the object is conserved (26). The con- 
sideration of the object’s well-being, which constitutes love, probably starts in this 
second anal phase; its first manifestation is the readiness to sacrifice the feces 
for the object’s sake. 

Just as frustrations in the oral period through animistic misunderstanding 
lead to the formation of specific oral anxieties, so do frustrations in the anal 
period form specific anal anxieties. As a retaliation for anal-sadistic tendencies, 
fears develop that what one wished to perpetrate anally on others will now hap- 
peh to oneself. Fears of physical injury of an anal nature develop, like the fear 
of some violent ripping out of feces or of body contents. 

The other erogenous zones and partial drives are somewhat neglected in 
analytic literature since they do not become leading executive zones. Neverthe- 
less, conflicts around them often play as decisive a role in the genesis of neuroses 
and in character formation as oral and anal eroticisms do. 


URETHRAL EROTICISM 

The appearance of infantile urethral eroticism is so closely interwoven with 
infantile genital eroticism that not much can be said about it before infantile 
genitality is discussed. Nevertheless, in later stages it often appears as a pre- 
genital opponent to genuine genital sexuality. The urethral-erotic child neces- 
sarily becomes aware of the difference between the sexes with reference to 
urinating. Thus urethral eroticism often appears in combination with the castra- 
tion complex, 

Certainly the primary aim of urethral eroticism is pleasure in urination* How- 
ever, there is also a secondary urethral-retention pleasure, analogous to the anal- 
retention pleasure, as well as conflicts revolving about it. This is more frequent 
in girls, probably for anatomical reasons. At any rate it does not seem justifiable 
to make retention pleasure synonyrpous with anal pleasure and excretory pleasure 
with urethral pleasure, as Ferenezi once tried to do (497). 

, The original aims of, urethral eroticism certainly arc autocrotic ones, just as 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 69 

are those of anal eroticism; later, urethral eroticism, too, may turn toward ob- 
jects, The urethral apparatus then becomes the executive of sexually exciting 
fantasies about urinating at objects, being urinated on by objects, or of fantasies 
in which the connection with urination is more concealed (1337). 

Children often actively wet their pants or bed for the sake of autoerotic 
, pleasure. Later, enuresis may develop as an involuntary neurotic symptom hav- 
ing the nature of an unconscious equivalent of masturbation {see pp. 232 In 
general, the pleasure in urinating may have a double character: it may have, in 
both sexes, a phallic and even sadistic significance — urinating being the equiv- 
alent of active penetration with fantasies of damaging or destroying— or it may 
be felt as a '‘letting flow,” as a passive giving oneself up and foregoing control. 
The aim of letting passively flow may be condensed with other passive aims 
in boys, like being fondled on the penis or being stimulated at the root of the 
penis or at the perineum (at the prostate) (1071). Whereas the active phallic part 
of urethral eroticism in boys is soon replaced by normal genitality, passive 
urethral-erotic aims may come in conflict with genitality, frequently condensed 
with anal aims; passive male urethral eroticism may, it is true, sometimes be 
combined with rather sadistic fantasies, as the analysis of cases of severe ejacula- 
tio praecox shows (14). The idea of letting flow frequently is displaced from 
urine to tears. In women, later urethral-erotic difficulties most frequently express 
conflicts centered around penis envy. 

Since the pleasure in the retention of urine is less outspoken than in the 
retention of feces, and in boys may even be entirely absent, the conflicts in the 
realm of urethral eroticism arc less characterized by a struggle between drives to 
eliminate and drives to retain than by a temptation to enjoy primitive erogenous 
pleasure in excretion and narcissistic pride in controlling the sphincter of the 
bladder. This pride is due to the fact that failures in urethral cleanliness are 
usually punished by putting the child to shame— much more so than failures in 
rectal cleanliness. It is not easy to say whence the deep connection between 
urethral eroticism and shame comes; but it can be stated that just as the idea of 
being eaten is the specific oral fear and the idea of being robbed of the contents 
of the body the specific anal fear, so shame is the specific force directed against 
urethral-erotic temptations. Ambition, so often described as an outcome of 
urethral-erotic conflicts (794> 881), represents the fight against this shame {see 
p.139). 

OTHER EROGENOUS ZONES 

The entire surface of the skin as well as all mucous memVanes function as an 
erogenous zone* All skin stimulation, touch, as well as temperature and pain 
sensations are potential sources of erogenous stimulation which, if it meets in^ 
tcrnal contradiction, may result in conflicts. Temperature eroticism in particular 



70 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

is often combined with early oral eroticism and forms an essential part of primi- 
tive receptive sexuality. To have cutaneous contact with the partner and to feel 
the warmth of his body remains an essential component of .all love relationships. 
In archaic forms of love, where objects serve rather as mere instruments for gain- 
ing satisfaction, this is especially marked. Intense pleasure in warmth, frequently 
manifested in neurotic bathing habits, is usually encountered in persons who 
simultaneously show other signs of a passive-receptive orientation, particularly 
in regard to the regulation of their self-esteem. For such persons, “to get affection” 
means “to get warmth.” They are “frozen” personalities who “thaw” in a 
“warm” atmosphere, who can sit for hours in a warm bath or on a radiator, 
Touch eroticism is comparable to scoptophilia, both representing the excite- 
ment brought about by specific sensory stimuli. After the achievement of 
genital primacy these sensory stimulations function as instigators of excitement 
and play a corresponding part in forepleasurc. If they have been warded off 
during childhood they remain isolated, demanding full gratification on their 
own account and thus disturbing sexual integration. Touch eroticism is not 
necessarily connected with scoptophilia. 

' In the case of a sculptor with neurotic inhibitions, specific fears which had 
become connected with the goals of touch eroticism formed the basis of the neu- 
rosis. 

It would be interesting to study the development of touch eroticism in blind 
persons (223). The sublimation of touch pleasure is of great importance to the 
ego in learning to master the external world (1405). 

/ Pleasure aroused by painful stimuli of the skin is the erogenous basis of all 
types of masochism {see p. 359). 

When the goals of skin eroticism are no longer autoerotic but have become 
directed toward objects, the archaic aim of incorporation is very distinct. “Intro- 
jection through the skin” plays a significant role in the magical thinking of all 
times as well as in the unconscious sexual fantasies of neurotics (1050). 

Skin eroticism is not always to be distinguished frorn muscle eroticism or from 
the sexualization of the data of depth sensibility (1338). Muscle eroticism is 
manifested in many games, sports, and so on, and, pathologically, in many conver- 
sion symptoms or in inhibitions of certain (se»ualized) muscle activities. Sexual 
pleasure gained from sensations of depth sensibility in neurotic phenomena is 
of far greater importance than is generally accepted (410, 444, 526, 837, 1384, 1386, 
1391). The importance of pleasures and fears around kinesthetic sensations as 
well as around sensations of the senses of equilibrium and space have been 
mentioned in connection with the archaic levels of the ego. Since the excite- 
ment (and the conflicts) aroused by these sensations form an essential com- 
ponent of infantile sexuality, the sensations themselves may later become repre- 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 7^ 

sentatives of infantile sexuality in general. Kinesthetic sensations of the early 
ego levels are experienced by adults and older children while falling asleep, 
which may contribute to disturbances of sleep if these sensations, because of 
their latent sexual significance, have a frightening effect. The return of old 
and unclear equilibrium and space sensations is often the external sign for a 
remobilization of unconscious infantile excitement. They seem to be of special 
importance wherever sensations of excitement turn into sensations of anxiety 
{see p. 203). 

The connection between anxiety and equilibrium sensations may have a deep 
physiological origin. Various authors have stressed the point that in the infant 
the fear of losing stability may form the pattern according to which, later on, 
other anxieties are built (72, 780, 1391). 


PARTIAL INSTINCTS 

Scoptophilia, the sexualization of the sensations of looking, is analogous to 
.touch eroticism. Sensory stimuli which are normally initiators of excitement 
and executors of forepleasure may, if too strong or repressed, later resist sub- 
ordination under the genital primacy. Wherever sensations of sense organs arc 
sexualized all the features described as characteristic for primitive perception 
can be observed again: activity of the perceptual organs, motility inseparably 
connected with perception, “incorporation” of the perceived with a resultant 
change of the ego along the lines of what has been perceived. Observation of a 
child who is looking for libidinous purposes readily shows what the accompany- 
ing features or prerequisites of pleasurable looking are: he wants to look at an 
object in order to “feel along with him.” 

This is especially clear in the analysis of perverse voyeurs. Those who want to 
observe couples always identify themselves in fantasy with one of the two part- 
ners or even with both (see p. 348)- 

Very often sadistic impulses are tied up with scoptophilia: the individual wants • 
to see something in order to destroy it (or to gain reassurance that the object is , 
not yet destroyed). Often, looking itself is unconsciously thought of as a sufa- ; 
stitute for destroying (“I did not destroy it; I merely looked at it”) . 

The typical obsessive idea in women that they must compulsively look at men’s 
genitals often represents a distorted expression of the sadistic wish to destroy 
men’s genitals. 

In many scoptophilic fantasies, the fantasy of incorporating through the eye 
the object seen is particularly clear (430). Scoptophdia is the' main component 
in children’s sexual curiosity which often has the quality of an instinctual drive. 



72 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


' “Knowing sexual facts’* may substitute for the observation of sexual facts and 
become a sexual aim of its own (249, 461, 1059). It may become displaced and give 
rise to the well-known continual asking of questions which can be so annoying 
to grownups. It may also become sublimated into a real interest in research, or 
its repression may block any intellectual interest, depending upon what experi- 
ences have become associated with this instinctive sexual curiosity (251, 561). 
“Primal scenes” (e.g. observing adults during sexual activities) or the birth of a 
younger sibling are the, most common experiences that may stimulate or block 
curiosity. 

Like other sexual components, scoptophilia may become the object of specific 
repressions (8). Freud once wrote a special paper about the various outcomes of 
these repressions (571). Extreme cases occasionally occur in shy, inhibited per- 
sons who actually do not dare to look at their environment. There arc specific 
fears that are dreaded by inhibited voyeurs as a talion punishment. The “evil 
eye” and “being turned to stone” are examples (1430). Generally, shyness may 
be called the specific fear corresponding to the scoptophilic impulse {see pp. 177 f.). 

The counterpart to scoptophilia is ex^hibitionism, which usually appears together 
with scoptophilia. Freud pointed out that this may be due to the fact that both 
have a common precursor in the sexual aim of looking at oneself (588). Due to 
this origin, exhibitionism remains more narcissistic than any other partial in- 
, stinct. Its erogenous pleasure is always connected with an increase in self-esteem, 
\ anticipated or actually gained through the fact that others look at the subject. In 
the perversion of exhibitionism this gain is used as a reassurance against castra- 
tion fears (see pp. 345 ff.) , In a magical way exhibitionism which gives erogenous 
pleasure may simultaneously be used to influence the onlookers in various ways, 
cither for apotropaic purposes (483, 634, 1249) or for showing them by magical 
gestures what they are supposed to do (555, 1296). 

The relationship to the castration complex causes exhibitionism to have a dif- 
ferent development in each sex. Since the man may quiet castration anxieties by 
exhibiting his genitals, masculine exhibitionism remains fixed to the genitals 
where it plays a role in sexual foreplcasure. In women, since the idea of being 
castrated inhibits genital exhibitionism, there is a displacement of exhibitionism 
to the body as a whole. There is no feminine perversion of genital exhibitionism, 
but nongcnital feminine exhibitionism plays a large role both inside and out- 
side the sexual sphere (736) {see pp. 346 f.). 

Just as there is a sexual impulse of touching and looking, so there arc also 
sexual impulses of hearing, tasting, and smelling. About the connections be- 
tween the so-called lower senses and sexuality, the same statements can be made 
as about the sexual connotations of kinesthetic sensations. The lower senses as 
well as the kinesthetic participate to a relatively great extent in the general 
orientation of the child; thus they arc also highly cathected with infantile sex- 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 73 

uality. Emotions (excitement as well as anxiety) which originally were con- 
nected with infantile sexuality may later be remobilized in a conflict situation 
around sensations of smelling, tasting, or hearing; again, where these sensations^ 
represent sexual impulses toward objects, the ideas of incorporation are in the 
foreground (ii, 420, 838). In states of regression, scoptophilia often recedes into 
the background, whereas auditory and olfactory conflicts come to the fore again. 

Actually phenomena of taste sexuality for the most part coincide with oral 
eroticism, and phenomena of smell sexuality with anal eroticism. Nevertheless 
their vicissitudes may be studied separately (838). 

Sadism and masochism likewise certainly may be designated as normal 
partial instincts; they are present in all children. It may be that sadism initially 
develops from the instinctive greediness with which the incorporation aims of the 
pregenital impulses are prosecuted, representing a way of striving for instinctive 
aims rather than an original instinctual aim in itself. Another root of sadism is 
the negative instinctual aim of getting rid (“spitting away”) of painful stimuli. 
Both greediness and hate become condensed when the destruction or the damage 
of an object turns into an instinctual aim of its own, the completion of which 
produces a kind of erogenous pleasure. 

All pregenital impulses, in their aims of incorporation, seem to possess a cer- 
tain destructive component. Unknown constitutional factors, and above all, ex- 
periences of frustration, greatly increase this destructive clement. In addition to 
oral and anal sadism other erogenous zones may serve as sources of sadism. It is'i 
often the specific repression of this sadistic component of infantile sexuality that ' 
later leads to conflicts and thus to neuroses. 

Masochism, the direction of the destructive component in sexuality against 
the individual’s own ego, is the counterpart to sadism. It is of special theoretical 
importance since its manifest aim of self-destruction seems to contradict the 
pleasure principle. The problem is whether this is due to a genuine self- 
destructive instinct operative “beyond the pleasure principle” (605) or whether 
this contradiction is only an apparent one, the masochistic phenomena being 
reducible to changes in the direction of sadistic drives, necessitated by the 
environment (601, 1277, 1299). This will be discussed in connection with the 
perversion of masochism (see pp. 358 £.). Concerning the partial instinct of mas- 
ochism, it may suffice to say that its erogenous basis is represented by the com- 
ponent of skin (and muscle) eroticism, which is aroused by (not too intense) 
painful stimuli. Freud called this erogenous masochism (613). All further phe-, 
nomena of masochism may be regarded as elaborations of this type of eroticism, 
provoked by certain experiences (see pp. 360 fl.). In principle, these elaborations 
can be understood m the following ways: 

1. They may represent a turning of sadistic impulses against the ego. 

2. They may represent a necessary evil in so far as experience has brought 



74 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


the conviction that pleasure can only be attained by bearing a certain amount of 
pain; thus enduring this pain becomes an unfortunate but unavoidable inter- 
mediary aim. The masochistic act may represent a “lesser evil”: by a self- 
destructive act one unconsciously pays a small price to avert a greater dreaded 
evil (1240). This is the psychology of “sacrifice.” A greater hurt is averted by 
voluntarily submitting the ego to an earlier and lesser one, 

3. The mechanism generally used to master traumatic experiences may com- 
plicate a person’s sexuality: when something unpleasant is expected, it may be 
anticipated actively to a controllable degree and at a known time. 

4, Experiences may inhibit activity and provoke a regression toward receptive 
behavior. Many masochistic phenomena appear in analysis as a strengthening of 
a passive-receptive giving oneself up for the sake of the pleasure of regaining 
participation in omnipotence. One’s own smallness can be enjoyed if it serves as 
a way of feeling that one participates in somebody else’s greatness (817, 819). 

THE PHALLIC PHASE; CASTRATION ANXIETY IN BOYS 

At the conclusion of infantile sexuality, the genital concentration of all sexual 
excitement is achieved. The interest in the genitals and in genital masturbation 
attains a dominant significance, and even a kind of genital orgasm makes its 
appearance. Freud called this phase the infantile genital organization or the 
phallic phase (609). 

The fact that a general genital discharge of all kinds of sexual excitement 
comes into being around the fourth or fifth year of life certainly does not mean that 
the genitals did not previously function as an erogenous zone. As an organ of 
erogenous sensitivity the genitals are highly effective from birth on; genital 
masturbation can be observed in infants. Genital erogeneity is as primary as the 
anal- and urethral-erotic elements, and is not created by a displacement of these 
elements (497). However, the genital organs and the urinary organs coincide to 
a high degree. The first genital strivings arc certainly closely interwoven with 
the urethral-erotic ones. 

Displacements of prcgenital cathexes onto genital impulses, however, do occur 
and increase the genital erogeneity. It is such displacement that is described in 
the formula: sexual excitement, wherever originated, becomes more and more 
concentrated at the genitals and eventually discharged in the genital way. 

Whatever the physiology of erogeneity may be, from a psychological point of 
view it must be said: there is not a specific oral libido, anal libido, and genital 
libido; there, is but one libido which may be displaced from one erogenous 
zone to another. But where certain fixations have developed, forces are at work 
that resist such a displacement, so that, for example, pregcnital fixations in 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 75 

neurotics hinder the progressive genital concentration of excitement during the 
sexual act. 

The displacements that govern the later vicissitudes of anal eroticism have been 
studied and described in detail by Freud and others (593, 832, 1634). Likewise 
a retrograde displacement of anal cathexes to oral functions may occur (1143, 
1489) and does occur regularly in stammering (see pp. 311 ff,). 

The infantile genital organization has common trends and differences as com- 
pared with adult sexuality. The similarities concern the genital concentration and 
the object relations. In general, the child at the phallic phase resembles the adult 
from a sexual standpoint more than is generally realized. Under our social 
conditions the main expression of the infantile genitality is masturbation, al- 
though acts resembling sexual intercourse occur, too. 

^ This is perhaps the moment to insert a few general remarks about masturba- 
tion (cf. 455, 580, 1588). Masturbation, that is, the stimulation of one’s own geni- 
tals for the sake of sexual pleasure, is normal in childhood; and under present 
cultural conditions is also normal in adolescence, and even in adulthood as a sub- 
stitute when no sexual object is available. If a person whose sexual activities are 
blocked by external circumstances absolutely refuses to make use of this way out, 
analpis dways reveals some unconscious fear or guilt feeling as the source of 
the inhibition (626). Patients who did not masturbate during adolescence like- 
wise reveal that their sexual urges were overwhelmed to a high degree by fear 
and guilt feelings. This indicates a poor prognosis; it is usually due to an espe- 
cially deep repression of infantile masturbation (1264, 1267). 

The earliest masturbation of infants is a simple autoerotic stimulation of thc^ 
genitals. Later the masturbatory activities become connected with fantasies con- 
cerning objects; in masturbation at the phallic phase, this is always the case (555). 

An important function of normal masturbation in childhood can be retraced 
from data furnished by dreams and by unconscious thinking. There, masturba- 
tion is regularly equated with play. The play of children, as we know, at first has 
the function of achieving a belated mastery of intense impressions; later it antici- 
pates possible events to a degree and at a time that suit the ego, preparing the 
child for future excitements (605, 1552). Similarly infantile masturbation may 
serve as a means of learning gradually the active mastery of the experience of 
sexual excitation. 

The genital discharge of masturbation may be used as a discharge for sexual 
wishes of any kind. Its psychological valence varies accordingly. Fears or guilt 
feelings vary with this valence. Although it is understandable that children whose 
masturbation is prohibited by adults develop fears and guilt feelings about their 
activity as such, and even, according to the animistic misunderstanding, expect 
fantastic punishments like castration, analysis shows that fears and guilt feelings 1 
concern rather the accompanying fantasies. In the phallic phase, these fantasies, 
as a rule, express more or less directly the Oedipus complex (to be discussed 
later). In adolescence and later life, frequently not only fears and guilt feelings 
arc still connected with masturbation but there is even a distinct resistance on the 



6 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


part of the patients against enlightenment about the harmless nature of masturba- 
tion. They seem to have some unconscious interest in believing that masturbation 
is a dreadful thing. Analysis, as a rule, shows that a guilt feeling arising from the 
tendencies of the Oedipus complex has been displaced toward the activity that 
serves as an outlet for these unconscious fantasies (the conscious masturbatory 
fantasies being a distorted derivative of the unconscious Oedipus fantasies); this 
displacement serves as a safeguard for the repression of the Oedipus complex. If 
the patients were to believe that masturbation as such is harmless they would not 
be rid of the guilt feeling; they would have to look for its source and might be- 
come aware of the repressed; thus they prefer to feel guilty “because they mastur- 
bate” (76, 789). ^ 

Masturbation is certainly pathological under two circumstances: {a) whenever 
it is preferred by adult persons to sexual intercourse, and (h) when it is done not 
occasionally for the purpose of relieving a sexual tension but at such frequent in- 
tervals that it reveals a dysfunction with respect to the capacity for sexual satis- 
faction. 

A preference for masturbation instead of sexual object relationships shows 
either directly a neurotic shyness and inhibition due to deep fears or guilt feelings 
?or there is a supposed “higher pleasure” achieved in masturbation, for the most 
,*part rooted in perverse fantasies which the patients do not dare to perform in 
reality or which actually could not be performed in reality; this, however, is due 
to unconscious fears connected with the idea of the sexual approach of real ob- 
jects. Masturbation in this case is a kind of perverse symptom, a substitute for 
sexual activity when real activity is neurotically inhibited. 

Overfrequent masturbation reveals its character as a neurotic symptom at first 
glance. It occurs when the capacity for satisfaction is disturbed. Problems regu- 
larly connected with this type of pathological masturbation arc (a) conflicts cen- 
tering around hostility and aggressiveness aimed at forcibly bringing about the 
lacking satisfaction, and (b) conflicts centering around the expectation of punish- 
ment for this aggressiveness. Unfavorable effects of the overfrequent masturba- 
tion may be perceived and even striven for as a well-deserved “castrajiea” punish- 
\ment, Masturbation of this type ceases if and when analysis succeeds^ in re- 
establishing the capacity for sexual satisfaction. 

Thus it is clear that masturbation in adults under some circumstances operates 
as a symptom of a neurosis; but it does not create a neurosis. However, it may be 
a part of a vicious circle: if neurotic shyness induces a person to masturbate rather 
than to approach an object sexually, he never learns that an object actually is capa- 
ble of giving a higher pleasure; the way to the masturbatory “substitute” is an 
easy one, and this ease may bring a kind of “spoiling,” that is, make the subject 
more unwilling to sustain the difficulties of attaining an object, and thus increase 
the shyness that was the first cause of his masturbation. 

Masturbation as such docs not produce neuroses. It has been proven clinically, 
however, that unsuccessful masturbation, that is, masturbation that increases 
sexual tension but is not capable of discharging it adequately, results in actual- 
neurotic symptoms (76, 1268), 

Since the genitals in the infant play only the part of primus inter pares, auto- 
crotic activities of little children arc by no means limited to genital masturbation. 
All erogenous zones may be stimulated autocrodcally. If, however, an adult or 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 77 

an older child indulges predominantly in various kinds of anal, oral, urethral, 
muscular (etc.) masturbation equivalents, analysis regularly reveals that this 
represents a regressive substitute for genital masturbation after the latter had been 
repressed (733). 

The relations of masturbation to neurasthenia, hypersexuality, and compulsion 
neurosis will be discussed in the respective chapters. 

There are, of course, also characteristic differences between infantile genitality 
at the phallic phase and the full genitality of the adult. Particularly characteristic 
for a boy at this age is a manly pride, which is limited, of course, by thoughts that 
he isn’t quite grown up, that his penis is smaller than his father’s or that of other 
grown men. This fact is a severe narcissistic blow; the children resent being 
children and the idea of having too small a penis may become the expression 
of later neurotic inferiority feelings which actually arc due to the impression 
of having been inferior to the father in the Oedipus rivalry (c/. 566). 

, The boy at the phallic phase has identified himself with his penis. The high 
narcissistic evaluation of this organ can be explained by the fact that just at this 
period it becomes so rich in sensations, and distinct tendencies actively to pierce 
with it come in the foreground. 

Up to then, active phallic impulses have been coexistent with passive strivings 
to have the .penis^ fondled (1071). Passive phallic strivings, subsequently often 
found at the basis of severe cases of ejaculatio praecox, arc regularly condensed 
with urethral-erotic strivings and, as a rule, actually governed by “prostate sex- 
uality” {see pp. 82 f .) . 

The fear that something might happen to this sensitive and prized organ is 
called casU'ation anxiety. This fear, to which such a significant role for the total 
development of the boy is ascribed, represents a result and not a cause of this 
high narcissistic evaluation {423). Only the high narcissistic cathexis of the penis 
at this period explains the efficacy of castration anxiety; its forerunners in oral 
and anal anxieties over loss of breast or feces (36, 39, 1466) lack the dynamic force 
characteristic of phallic castration anxiety. 

Castration anxiety in the boy in the phallic period can be compared to the 
fear of being eaten in the oral period, or the fear of being robbed of the body’s 
contents in the anal period; it is the retaliatory fear of the phallic period; it repre- 
sents the climax of the fantastic fears of body damage. 

In the last analysis the idea of castration may be based upon traces of the 
ancient biological reflex of autotomy (1242) ; less deeply but more certainly it is 
based upon the archaic retaliatory idea of talion: the very organ that has sinned 
has to be punished. 

However, children’s surroundings meet their disposition toward such fantastic 
ideas of punishment more than halfway. Many adults, upon seeing a boy 
masturbate, still threaten him with "cutting it o£ ” Usually the threat is less 



7^ THE PSYCHOANALYTIC THEORY OF NEUROSIS 

direct, but other punishments are suggested, either seriously or jokingly, which 
the child interprets as threats of castration (1051). But even experiences which 
objectively do not contain any threat may be misinterpreted in this sense by a 
boy with a guilty conscience; for example, the experience that there are really 
beings without a penis: the observation of female genitals. Sometimes an 
observation of this kind lends a serious character to a previous threat that had 
not been taken seriously (566). In other cases the achievement of the phallic 
phase alone may suffice to activate past threats which had not made too intense 
an impression during pregenital periods. 

The castration anxiety of the little boy may be represented by manifold ideas, 
the special form of which becomes understandable through his individual his- 
tory. There are infinite possibilities; a few of the more frequent ones will be 
mentioned. 

After an operation the castration fear may be displaced to the operated area— 
for example, after a tonsillectomy. A child who has had to witness the decapita- 
tion of a fowl or has been impressed by stories about decapitation may substitute 
the idea of decapitation for that of castration. Conscious or unconscious fears of 
blindness or of injury to the eye, and also of being petrified, point to conflicts 
around scoptophilia. The localization of the fear at the thumb is indicative of 
thumbsucking. 

The nature of the danger that is believed to be threatening the penis likewise 
varies. It might be believed that the penis is endangered by a masculine enemy, 
that is, by a penetrating, pointed tool, or by a feminine enemy, that is, by an en- 
compassing instrument, depending upon whether the father or the mother 
appeared as the more threatening person, or depending upon what special 
fantasies the boy has had about sexual intercourse. Persons with oral fixations 
may fear that the penis will be bitten ojff, which results in confused ideas made 
> up of both oral and genital elements. 

Sometimes specific experiences shape rather grotesque forms of castration 
fear. 

A boy who became sexually excited by equilibratory sensations aroused by 
turning himself ^around was later afraid his penis might fly away, 

An orally oriented patient, in whom sexual gratification unconsciously was 
thought of as an eating process, and who had made his father his main sexual 
object, had heard about cancer and microbes. After having seen the female geni- 
tals as a young boy, he had developed the following fantastic idea: if I dare to 
eat my fathcr^s penis (or what comes out of my father^s penis), the little bugs, 
which are the matrix of future children, will devour my penis from within. 

Sometimes boys arc less frightened by the idea that some harm may be done 
to their penis in the future than by the idea that their masturbatory activity nnay 
aaually have injured their penis, that their penis is not a whole one any more, 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 79 

and that this may be found out some day. This might be called the feminine 
type of castration complex in boys. Circumcision or medical treatment in the 
genital region may facilitate its development, as may the sight of an adult’s or 
older boy’s bigger penis. Men with this type of castration complex frequently 
suffer from the conscious obsessive fear that their penis is too small. Their con- 
viction is due to an impressive observation in childhood about the size of some- 
body elsc’s penis when their penis actually was small. ‘‘Femininity” in boys does 
not always have the meaning: ‘T think I am already castrated ” On the contrary, 
a turning to femininity (which is a turning away from an active use of the penis) 
often is attempted as a reassurance against a possible future castration : “If I act 
as if I had no penis any more they will not cut it off.” Or even: “If castration 
cannot be avoided anyhow, I prefer to perform it actively in anticipation of what 
must come, and I shall at least have the advantage of ingratiating myself with 
the threatening person.” 

That adults so easily and eagerly threaten or joke about castration is, of course, 
an expression of their own castration complexes. Frightening others is an excel- 
lent method of quieting one’s own fears. In this way castration complexes arc 
passed on from generation to generation. We do not know how they came into 
being originally, but certainly they have a long history of development. 

In many primitive (and civilized) societies, the adult generation places restric- 
tions on the sexual freedom of the younger generation. The initiation rites that 
associate sexuality with painful experiences are an example of such conditions 
imposed upon the younger generation (1284). It may be that in certain cultures 
genital injury was actually perpetrated against those who rebelled. 

The intensity of castration anxiety corresponds to the intense evaluation of 
this organ during the phallic phase. The same valuation makes the boy decide, 
when he faces the question of cither giving up his genital functions or endan- 
gering his penis, in favor of renunciation of the function. An adult person might 
ask: “What good is an organ when I am forbidden to make use of it?” la the 
phallic period, however, the narcissistic factors outweigh the sexual, so that 
possession of the penis is the major objective (612). 

Problems of this kind are due to another characteristic of the phallic stage. 
The boy at this age, according to Freud (609), docs not yet take the possession of 
a penis as a matter of sex determination. He differentiates not in terms of male 
and female but in terms of with penis and castrated. When he is forced to accept 
the existence of persons without a penis, then he assumes that they once did 
have one but lost it. Analysts, who have confirmed such findings, have asked 
the question as to whether this way of thinking may not be a result of a 
previous repression. It may be that the boy has a more primary reason to fear 
the female genitals than castration fear (oral anxieties of a vagina dentata as a 
retaliatory fear for oral-sadistic impulses) and that he therefore tries to deny their 



So 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


existence. The idea that girls once had a penis but that it was cut ofl would rep- 
resent an attempt at such a denial. True, it brings with it the anxiety “This 
could happen to me, too,” but it has the advantage of denying the primary exist- 
ence of the feared female genitals (898) . However, one does not get the impres- 
sion that boys find any consolation in knowing that creatures have had their 
penises cut off; this idea seems, rather, to be very frightening. Furthermore it 
seems natural for the boy to assume, as long as he is not taught otherwise, that 
everyone is built just as he is. Thus this assumption is not necessarily based on 
fear; rather, the insight that the assumption is incorrect arouses the fear. 


THE PHALLIC PHASE IN GIRLS; PENIS ENVY 

It is usual to refer to a phallic period in girls also (146, 609). What is meant 
by this.f^ First, that the clitoris at that time is the part of the genital apparatus that 
is richest in sensations and that attracts and discharges all sexual excitation. It is 
the central point of masturbatory practices as well as of psychic interest. Second, 
it means that the girl, too, divides people into '‘phallic” and “castrated”; that is, 
the knowledge that there are creatures with a penis is typically reacted to not only 
by an attitude “I, too, would like to have that,” but also by the idea “I once did 
have it but I lost it” (20, 555, 617, 626). 

Objections have been raised to these findings of Freud; however, they do not 
seem convincing. Concerning clitoris sexuality, there is no doubt that it plays 
the most prominent role in the girl’s sexual excitement. True, it is not the only 
infantile female genital sexuality. Several authors have shown that there is also 
an early vaginal sexuality (360, 1079) . Others have gone so far as to state that 
clitoris crogencity appears so strong because it is an overcompensating substitute 
for a repressed vaginal organization of the libido (744, 815, 1161). Certainly it 
has to be admitted that the genital excitability of girls is not limited to the 
clitoris. No one doubts the high erogenous sensitivity of the labia, the vulva, or 
the introitus. (However, as a rule, stimulation of these parts leads to discharge 
by the clitoris in this period.) It is difficult to judge whether the vagina beyond 
the introitus plays a regular role in this infantile stage. Clinical findings of for- 
eign bodies in the vagina or even uterus apparently justify such an assumption 
(360). However, one has the impression that an infantile vaginal sexuality can 
hardly be separated from sensations at the vulva or labia. There is no evidence 
that it is present regularly or with great intensity, that it is then repressed, and 
that a reacting to such regular repression would be the cause for the intensity of 
clitoris sexuality in little girls (419, 421). 

The objections to the regular soccurrcnce of a primary envy reaction to the 
sight of a penis have been supported by the following argument. Analyses 
undergone by women with a strong penis envy show that these women, have 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 8l 

gone through a ‘‘flight from womanhood” (812), that they have developed some 
fear of their own femininity and have therefore built up a reactive penis envy. 
There is no doubt that such clinical findings are correct; but they do not con- 
tradict the existence of a primary penis envy. In the analysis of compulsion 
neurotics we find at first a host of repressed anal and sadistic drives, then later 
discover that deeper levels contain unconscious genital strivings, which have 
been warded off by a regression to anal-sadistic strivings. We, then, do not say 
that the reactive nature of anal-sadistic strivings contradicts the existence of an 
original anal-sadistic period in the child’s libidinal development; we under- 
stand, rather, that the reactive strivings have used regressive paths. Similarly a 
woman who has made a flight from womanhood may develop a secondary penis 
envy by a reactive reinforcement of a primary penis envy. Often this can be 
proven clinically (421, 899, 1007, 1313). 

Certainly the little girl, like the boy, as long as she is not taught otherwise, 
feels that everyone is built as she is. When she has to realize that this is not true, 
she feels this as a severe disadvantage. It has often been asked what determines 
this surprising reaction: is it actually only a psychological consequence of the 
anatomical distinction between the sexes (617), or is it rather a reaction to pre- 
vious social experiences which gave the impression that girls are inferior (814, 
1538).? 

There is no doubt that every girl has the feeling that the possession of a penis 
provides direct erogenous advantages in masturbatory or urinary respects; the 
possession- of a penis, in the girl’s eyes, makes the possessor more mdependent 
and less subject to frustrations (8ir). This feeling is probably due to the concen- 
tration of all sexual feelings at the clitoris at this time, the clitoris being “inferior” 
as compared to the penis. The envy usually is condensed with the idea that the 
lack of a penis is a kind of punishment, whether deserved or unjust; in this 
respect the girl’s idea of having lost a penis and the boy’s idea that he may lose 
his penis are completely analogous. In the girl, too, the animistic misinterpreta- 
tion of the world is effective as is the expectation of talion punishment. The 
fact that the girl thinks “I have been punished” whereas the boy is afraid “I may 
be punished” is responsible for remarkable differences in their respective later 
development (612, 617). 

In older girls and in adult women, however, things become more complicated. 
In our culture, there are many reasons why women may envy men. Masculine 
strivings of any kind may be added to the primary penis envy, especially after 
unfortunate experiences, frustrations, and repressions in the feminine field. What 
is regarded as masculine and as feminine varies enormously in difFerent cultures, 
and these cultural patterns and the conflicts around them complicate tfic 
“psychological consequences of the anatomical distinction” (617). In this respect 
Fromm’s summary seeps wholly accurate: “Certain biological differences rwmlp 



82 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


in characterological differences; such differences are blended with those which 
arc directly produced by social factors; the latter are much stronger in their 
effect and can either increase, eliminate, or reverse biologically rooted differ- 
ences” (655). 

Evidence substantiates Freud’s postulation of a phallic period in girls if it is 
kept in mind that this expression implies a physiological dominance of clitoris 
sexuality and a psychological conflict around penis envy. The postulation seems 
more problematic when it is assumed to imply that clitoris sexuality would 
always go hand in hand with outspoken masculine fantasies, and that clitoris 
sexuality would have as its aim the penetration of a hollow organ, as a rule of 
the mother, with the regular unconscious aim of procreating a child with her 
(1006) . This would simply mean that the girl prior to the latency period is a kind 
of boy. Certainly it sometimes occurs that the preoedipal mother fixation is 
accompanied by masculine genital wishes (626, 628) ; but this is not always the 
case. Unquestionably, pure feminine fantasies can accompany clitoris masturba- 
tion. It is true that small girls regularly have impulses to enter into the mother; 
but as a rule this is not thought of as a clitoris activity but much more as an oral 
fantasy stemming from the earliest infantile period. Such fantasies arc con- 
structed in terms of penetrating into the mother’s body with the teeth and of 
eating its contents (958). Some authors have been misled by such oral-sadistic 
fantasies in women to write of an early phallic phase, which is supposed to occur 
much earlier than Freud’s phallic phase (761). The fantasy of having a child 
with the mother actually arises frequently in the unconscious of girls; but usually 
they fantasy the mother as the creator and themselves as the bearer of the 
child (421), 

The significance of the phallic period for the female sex is associated with the 
fact that the feminine genitals have two leading erogenous zones: the clitoris 
and the vagina. In the infantile genital period the former and in the adult 
period the latter is in the foreground. The change from the clitoris as the leading 
zone to the vagina is a step that definitely occurs in or after puberty only, though 
it certainly is prepared and introduced by the push toward passivity which the 
girl experiences when shifting from her preponderant mother fixation and turn- 
ing toward the father. It offers new opportunities for disturbances in develop- 
ment when either a strong fixation on clitoris sexuality or a repulsing fear 
of vaginal sexuality or both conditions work against the establishment of vaginal 
primacy. However, there is an analogy to this complication in the masculine 
\ sex. It is strange how litde it is noted in analytic literature that the masculine 
genital apparatus, corresponding to its “bisexual” nature (216, 1243), likewise 
possesses two centers. If passive men, in whom passive anal and urethral tenden- 
icics are predominant over active phallic ones, arc questioned as to where they 
\ctl the most intense sensations, they answer with aboyt equal frequency: at 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 83 

the root of the penis, at the perineum, or in the rectum. What they actually 
refer to is a point that is not accessible from the outside and that is equidistant 
from the root of the penis, the perineum, and the rectum. This point lies in the 
prostatic part of the urethra and corresponds to the embryologically important 
seminal colliculus. Much of what is supposed to be anal and urethral sexuality 
^ in men is in reality collicular sexuality (798, 942) . However, the seminal collic- 
ulus plays a lesser role in the life of men than the clitoris does in the life of 
women. 

It has been stated that the boy’s envy of the woman’s ability to bear children 
is as intense as the girl’s envy of the boy’s penis (163). This argument, however, 
is not very convincing. It is true that children may have a passionate wish to give 
birth to babies, a wish that is doomed to frustration. But this disappointment 
affects girls as well as boys — ^little girls cannot have babies cither. But litde boys 
can actually get pleasure from their penis. 


,THE ARCHAIC TYPES OF OBJECT RELATIONSHIPS 

The second point of view in the development of infantile sexuality is the 
alteration of the relationships to objects. Because the two aspects of sexual 
development are interwoven, this point has already been touched upon. In gen- 
eral, this development proceeds from an objectless state to aims of incorporation 
(first total, then partial), then to other ambivalent aims in which the object is 
merely an instrument for the sake of one’s own pleasure, and finally to real love. 

The state without objects is the primary narcissistic state, the sexual aims of 
which arc entirely autoerotic. The very first types of object relationships have 
been discussed in connection with the ego development. What was called primary 
identification there is identical with what might be called oral incorporation 
from the point of view of the instincts. The first positive instinctual behavior 
toward a desired object consists in diminishing the distance between oneself and 
the object, and finally in swallowing it (later limited to taking it into the mouth). 
The first negative instinctual behavior toward a repulsive object consists in in- 
creasing the distance and in ‘‘spitting it out” (later condensed with eliminating 
it according to tl^c pattern of defecation). The first incorporation is tied up with 
the objective destruction of the object, just as the object image disappears again 
when satisfaction is reached, Thisis the common root of hate and of love. Later 
the object is conserved at least for the purpose of having it available for the next 
time of need. There is no doubt that orality is the model for all incorporation; but 
similar aims are imagined in the realm of all other erogenous zones, too. Special 
mention has been made of the introjection through the skin (1050) and through 
the eye (430) ; respiratory (420) and auditory introjection (838) have been de- 
scribed. The personality of the object to be incorporated seems to be of very 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


84 

limited importance. As a subject it does not matter—it only has to be able to 
procure satisfaction and may disappear afterward. The image of mother has 
this potentiality whereas the image of stranger does not offer the hope of grati- 
fication but increases tension (73). 

An object relationship may be called ambivalent, it has been stated, as soon as 
an impulse to destroy and an impulse to preserve the object coexist. The first 
aggressive reaction is represented by spitting away. Later, aggressive reactions 
may also be represented by introjection. Abraham showed how later conflicts of 
ambivalence may be solved by the aim of partial incorporation (26). A part of 
the object is made a permanent property by incorporation, while the remainder 
is preserved in the external world. 

The early object relationships are complicated by the fact that direct erotic aims 
are as yet not clearly distinguished from the narcissistic aim of participating again 
in omnipotence. Consideration of the object begins to develop during the anal 
period (26). The earliest consideration, however, is still dominated by narcis- 
sistic aims and is ambivalent. The object is to be influenced by every means 
available to offer the necessary satisfaction. If this is achieved, the object fuses 
again with the ego. Some neurotic persons remain fixated to this phase, governed 
by passive aims, incapable of any active consideration of the loved object. Be- 
havior of this kind is also called narcissistic, though it is entirely different from 
the objectless primary narcissism. 


LOVE AND HATE 

Before the egoistic attitude to the objects with all traces of the ambivalence 
associated therewith is overcome, children frequently are in love with them- 
selves (secondary narcissism). They arc capable of distinguishing objects and of 
loving objects as long as the objects procure satisfaction. If they do not, the 
child “identifies” with the object and loves himself instead of the object (608) . 
This, however, is certainly not yet love. One can speak of love only when con- 
sideration of the object goes so far that one’s own satisfaction is impossible 
without satisfying the object, too. This kind of feeling oneself in union with the 
object has surely something to do with identification. On the other hand we 
distinguish between object relationship' and identification and we assume that 
J understanding for the real object stops where identification becomes the means 
lof the relationship. In love, it must be a kind of partial and temporary identifi- 
cation for empathic purposes which cither exists alongside the object relationship 
or alternates with it in short intervals. We know nothing about the specific na- 
ture of this identification. We can only say that the experience of a full and highly 
integrated satisfaction facilitates it, and that genital primacy (ability to have an 
adequate orgasm) is the prerequisite for it (81, 1270, 1272)* 



DEVELOPMENT OF INSTINCTS^ INFANTILE SEXUALITY 85 

Persons in whom the genital primacy is lacking, that is, orgastically impotent 
persons (1270), are also incapable of love. The full capacity for love not only 
changes the relations toward other persons but also the relation toward one’s own 
ego. The contrast between object love and self-love again is a relative one: in 
primary narcissism there is self-love instead of object love; in secondary narcis- 
sism there is a need for self-love (self-esteem) which overshadows object love. 
With the capacity for object love another, higher, postnarcissistic type of self- 
respect becomes available (652). 

It can be stated that at the height of full genital satisfaction identification 
comes back on a higher level; a feeling of flowing together, of losing one’s in- 
dividuality, of achieving a desired reunion of the ego with something larger 
which has been outside the boundaries of the ego, is an essential constituent of 
this satisfaction. 

Consideration of the object as a condition of a full development of object re- 
lationships was called the erotic sense of reality by Ferenezi (505), who pointed 
out that a full appreciation of reality is lacking in persons who remain fixated at 
the precursivc stages of love. 

In the establishment of this consideration the development of tenderness plays 
a decisive part. But what is tenderness.? Freud described it as an outcome of in- 
hibition in the aim of sensual tendencies (555). Other authors have doubted this 
origin, stressing the fact that tender and sensual object relations do not exclude 
each other, and that a real love necessarily comprehends both tender and sensual 
strivings. If tenderness and sensuality so often arc actually in conflict with each 
other, this is due to a secondarily defensive isolation rather than to the basic con- 
tradictory nature of these two conflicting forces. Schultz-Henckc tried to reduce 
them to different erogenous sources, suggesting that sensuality might be rooted 
in genital eroticism and tenderness in skin eroticism (1412); there is, however, 
a genital tenderness as well as a cutaneous sensuality. Thus it seems that the 
development of tenderness is not very likely to explain the type of “higher iden- 
tification” which in love determines consideration of the object; it may rather be 
the other way round, that tenderness comes into being when object strivings 
(probably of an aim-inhibited nature) meet with the aforementioned kind of 
identification. 

The fact that in this type of identification there is also a regressive element in 
love is clearer in women than in men. The passive aim of female sexuality is 
more closely related to the original aims of incorporation than is the active aim 
of male sexuality. Therefore, passive sexuality has more archaic features than 
active sexuality. The aim of being loved is more stressed in women than the aim 
of loving— the narcissistic need and the dependency on the object arc greater 
(585)- I 

The regressive element in love, however, is not limited to women. In the proc- 



86 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


ess of falling in love it comes to the fore with men, too. In this state it is obvious 
that an archaic type of self-regard (or even of omnipotence) comes back again 
in an oceanic feeling of losing one’s ego boundaries (622). The ego accentuation 
is displaced from the ego to the partner: “I am nothing, the partner is every- 
thing”; and further: '1 become everything again by being permitted to partici- 
pate in the partner’s greatness” (606). This idea may even falsify the “erotic 
sense of reality” (505) : when a person in love estimates his partner’s virtues he 
usually is not very realistic; by his projection of all his ideals onto the partner’s 
personality, the reunion with him becomes the more enjoyable (850). This cir- 
cumstance was characterized by Freud in the statement: the state of being in love 
represents a “group of two” (606). There is a gradual transition from the state of 
being in love to the perversion of extreme submissiveness (see pp. 351 ff.) . 

The nature of the identification on a higher level which constitutes love is still 
obscure; more is known abput the time in which this decisive step normally is 
taken. According to Abraham (26) this takes place during the anal phase. It is 
established as soon as “retention pleasure” outweighs “elimination pleasure.” 
A kind of tender feeling toward one’s own feces (which once were ego but now 
are objects) usually forms as important a forerunner of tenderness as do feelings 
toward the mother’s breast, the bottle, or the mother herself. All three of these 
were also once ego but now are objects. 

Not only love but hate also presupposes a complete awareness of the object, 
which capacity is still lacking in the small child. Small children actually destroy 
objects and push around and hurt other children, and so on, probably not be- 
cause they have a positive striving for destruction but rather because they do not 
care at all; their object interests are limited to potential sources of gratification 
and to potential threats, their “aggressive” goal is the end of uncomfortable situ- 
ations, not a positive pleasure in destroying. The goal of positive destruction 
originates later, probably first as a means to enforce other goals (as a quality 
with which a goal is pursued in the case of difficulties or frustrations) and then, 
subsequently, as a goal in itself. It has already been explained why a pregenitally 
oriented organism is more inclined to include destructiveness with its erotic aims. 
In a normal gcnitally oriented person aggressiveness is a means of achieving his 
goals under certain adverse circumstances; the repression of these means may 
create as much a handicap in life as the repression of the ability to love, 


SOCIAL FEELINGS 

The object relationships of a mature, person do not consist solely of love and 
hate. There arc also: (i) Object feelings of less intensity, sympathy and antipa- 
thy of various degrees. They are not essentially different from love and hate; 
libido-economic changes may make them turn into love and hate, which proves 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 87 

that they are o£ a libidinal nature and originate through inhibition of aims. 
(2) In mental development the previous phases never disappear entirely; thus 
normal persons also have, to a certain degree, ambivalences and incorporation 
aims. The latter are responsible for the many object relationships that still are 
interwoven with identifications. (3) Among these identification relationships 
one type is of special importance: the use of objects as ideal models to be imi- 
tated or as bad examples to be avoided. (4) And this in turn forms a transition 
to the type of relations in which an object is not reacted to as such but is used as 
an instrument to relieve some inner conflict. Different types of such use will be 
discussed later (see pp. 496 fF. and 508 ff.) . 

All these types of object relationships which are not love or hate may have orig- 
inated in childhood relationships to persons other than the parents, for example, 
to siblings. They are basic for what is called social feelings, that is, for the forces 
within individuals that favor group formation. Aim-inhibited strivings (under 
our cultural conditions especially of a homosexual nature) , identifications (which 
are responsible for the blocking of intragroup aggressions, so essential for any 
group formation), and the choice of models and examples among objects arc the 
mechanisms at the basis of group formation (606, 607, 624) . 

Freud clarified the relation of “aim-inhibited strivings’’ and “identifications” 
on the one hand and “choice of models and examples” on the other in group 
formation by stating: if several persons have set the same object in the place of 
their superego (as their ideal model or as their meaning example), they identify, 
consequently, with each other and develop tender aim- inhibited feelings toward 
one another (606), Eedl complemented this formula by stating: if several persons 
have used the same object as an instrument to relieve similar inner conflicts, they 
also tend to identify with each other and to feel tenderly toward one another 
(1258). 

It is perhaps worth while to add that social psychology is by no means limited 
to the study of what is going on in individual minds when groups are formed in 
this way or of how such groups operate; it must likewise face and solve problems 
of an entirely different nature, namely, not only that of subjective but also of 
objpetive groups, of the similar effects that similar external stimuli have on dif- 
ferent individuals. 


THE MOTHER AS THE FIRST OBJECT 

The first object of every individual is the mother. This statement is not to be 
taken literally, for there are no grounds for assuming that the physical act of 
birth in any way binds the child psychologically to the mother. That person who 
performs the first care of the child is to be considered the mother. Groddeck 
maintained that children fed by a wet nurse may for the rest of their lives manifest 
conflicts or difficulties that originate from the situation of having had ‘'two 
mothers” (720). Clinical experience does not confirm this idea which seems 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


highly improbable. In the beginning there are no images of objects; the first oh 
jcct representations are diffuse and the process of forming images of objects takes 
place very gradually. The idea of mother is certainly not present at the beginning. 
Though it is very difficult to describe, we must assume that the first ideas con- 
cerning things which may bring satisfaction but which arc momentarily absent 
include simultaneously the mothers breast (or the bottle), the person of the 
mother, and parts of the child’s own body. The actual perception of a “person,” 
which would make a distinction between mother and wet nurse possible, does 
not exist as yet. Later on, the child does learn to differentiate impressions; then 
the first differentiation is probably between “trusted” and “strange” impressions. 
“Strange” is felt as “dangerous”; narcissistic supplies are expected from the 
“trusted” sources. The “trusted” parts of the mother are “loved”; gradually the 
mother is recognized as a whole and “oral union with the mother” becomes the 
simultaneous aim of the undifferentiated erotic and narcissistic needs. In this way 
the mother attains a unique possibility for exerting influence. 

The development of object relationships in the masculine sex is simpler be- 
cause the boy in his later developmental states remains bound to his first object, 
the mother. The primitive object choice, developed from the care of the child, 
takes the same direction as that which arises from the attraction of the opposite 
sex. Of course the boy loves his father and other objects, too, and of course the 
boy suffers frustrations from his mother and may also hate her; but the boy’s 
love for his mother remains the dominant striving during his infantile sexual 
phase. The contradictory strivings of love and hate, or of love for mother and 
love for father, and so on, seem temporarily to coexist without disturbing each 
other. It is characteristic of the primary process that contradictions may coexist 
without leading to disturbing conflicts. As the ego becomes stronger this grad- 
ually becomes impossible and conflicts do arise. The boy begins to realize that 
his love for the mother, his identification love for the father (based on the for- 
mula “I would like to be as big as he is and be allowed and able to do all that 
he does”), and his hatred of the father (based on the fact that the father has cer- 
tain privileges) conflict with one another. “I love mother and hate father because 
he takes mother for himself” is an expression for the way in which the boy’s im- 
pulses typically are condensed, under the conditions of family upbringing. This 
is called the positive Oedipus complex (552); it usually starts in the third year of 
life, occasionally earlier (93, 955), and reaches its climax in the fourth and fifth 
year. The high point of the Oedipus complex coincides with the phallic stage of 
libido development. We speak of a negative Oedipus complex in a boy when 
love for the father prevails and the mother is hated as a disturbing element in 
his love for the father (608). Certain traces of this negative Oedipus complex 
are normally present along with the positive. Constitutional factors and experi- 
ence may augment this greatly. 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 

A man patient with a very strong and ambivalent father complex had the fol- 
lowing dream: ‘T got a long letter from my father. He wrote me that somebody 
had died. Finally, he asked me whether I would marry him.’* 

In general, boys with a special development of the negative Oedipus complex 
have repressed phallic strivings toward the mother and mobilized pregenital pas- 
sive aims toward the father instead. Sometimes, however, things are a little more 
complicated. Analysis of pregenitally oriented compulsive characters or of certain 
homosexuals sometimes shows that an infantile phallic period has not disap- 
peared with the repression of an Oedipus complex directed at the mother, but 
that the repressed impulse connected with the penis had been directed toward the 
father. Love and competition are not mutually exclusive. The normal identifica- 
tion of a boy with his father, characterized by the formulae, *T should like to be 
like father,” “I should like to have a penis like father’s,” ‘T should like to partici- 
pate in father’s penis,” may, in certain cases, grow into a kind of love which may 
best be described as an apprentice complex, a temporary feminine submission to 
the father in order to prepare oneself for a later masculine competition with him. 

If this love meets a castration threat, this may result in an abandonment of the 
phallic position and make the boy turn to the mother again, but no longer in a 
phallic Oedipus striving but rather in a prcgenital, passive, protection-seeking, 
identifying way. 

It has been mentioned that in the phallic phase the narcissistic fear about the 
penis is stronger than the object relationship. Thus finally, castration anxiety 
leads to the renunciation of the boy’s passionate Oedipus love for his mother, 
since its gratification could be attained only at the price of endangering the 
penis (612). 

THE CHANGE OF OBJECT IN GILLS 

The object development in girls is somewhat more complicated. The girl 
undergoes one more step of development than the boy, namely, the transfer from 
the first object, the mother, to the opposite sex, the father. This transition takes 
place relatively late, between the ages of three and six; nevertheless it must be 
assumed that it is conditioned not only by experiences but is biologically founded 
as well. (Men’s beards do not appear before puberty and still this phenomenon 
is not psychologically conditioned.) The biological foundation does not alter 
the fact that it is interesting to study the psychological connections under which 
this change of object takes place, especially since these mental factors not only 
influence the form the biologically dctcrinined process will pursue but also deter- 
mine many complications and developmental disturbances that are important 
for the neuroses (626, 628, 1090). 

The most important experiences that precipitate, facilitate, impede, or form 
the change of object are disappointments coming from the mother, which cause 
a turning away from her. Among these, weaning, training for cleanliness, and 
the birth of siblings have the most important repercussions. However, these dis- 
appointments are borne by boys without turning them away from the mother^ 



90 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


There is another disappointment, however, which is specific {or the female sex. 
It was already mentioned that girls typically react to the discovery of the penis 
with a primary penis envy. Many girls, who for certain reasons have tendencies 
toward self-reproach, may react to this primary penis envy with strong guilt 
feelings, as though they themselves had injured their bodies. But all o£ them 
make the mother actually responsible: she deprived them o£ something, or 
she took something away from them (626). It is this specifically feminine 
disappointment that forms the main motive for the turning away from the 
mother. Remobilized anal- and oral-receptive elements prepare the ground 
for the subsequent femininity. The aim is now to get from the father the 
“supplies” that the mother had denied them. In the girl’s fantasy, the idea 
“penis’* is replaced by the idea “child,” and the clitoris as a leading zone may 
again be regressively replaced by anal and especially oral — that is, receptive 
—demands (612, 617, 626). This revival of receptive longings has various conse- 
quences. Normally it prepares for the later vaginal sexuality, which often shows 
characteristics of an oral or anal origin of its cathexes (66), and of normal female 
receptivity. Actually pregnancy is a kind of incorporation. In pathological cases 
oral-sadistic strivings, too, may become remobilized and influence the woman’s 
later sexuality in an unfortunate way. Certain character disorders are rooted in 
experiences connected with this step. 

The described turn toward passivity may, of course, in predisposed girls also 
mobilize the masochistic sexual components discussed above {see pp. 73 f.), and 
thus give rise to the development of a more or less pronounced masochistic per- 
version. In no way, however, does it seem warranted to identify the passive aims 
of normal female sexuality with masochism (322). 

It is understandable that this development is open to many disturbances and 
that conflicts about the preoedipal love for the mother play an important role in 
the neuroses of women. In normal development, too, the relationship of women 
to their mothers is more frequently ambivalent than is that of most men to their 
fathers. Some remnants of the preoedipal mother fixation are always found in 
women. There are many women whose masculine love objects have more char- 
acteristics of their mother than of their father (626, 628). 

The aims of the preoedipal mother fixation usually are first of all pregenital 
ones; but there are certainly also genital impulses directed toward the mother, 
and it is the genital disappointment that leads to the final renunciation. How- 
ever, there is no reason to assume that the little girl originally is in every respect 
a little boy and that a negative Oedipus complex regularly would precede the 
positive (1006, 1007; cf. also 190, 421, 894, 899, 1313). 

Once the attachment to the father, is accomplished, the girl, under normal cir- 
cumstances in our cultural milieu, develops an Oedipus complex analogous to 
that of the boy. The love for the father is combined with a guilt-laden jealousy 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 9^ 

hatred of the mother. Of course this jealousy hatred is condensed with old hate 
impulses from the preoedipal phases. 

The general discrepancy in the development of object relationships for both 
sexes was expressed by Freud in the following formula: The masculine Oedipus 
complex is resolved by the castration complex; it is given up because of castration 
anxiety. The feminine Oedipus complex is brought about by the castration com- 
plex; out of disappointment over the lack of a penis, the girl’s love turns toward 
the father (612). 

THE OEDIPUS COMPLEX 

In both sexes, the Oedipus complex can be called the climax of infantile sexual- 
ity; the erogenous development from oral eroticism via anal eroticism toward 
genitality, as well as the development of object relationships from incorporation 
via partial incorporation and ambivalence toward love and hate, culminate in 
the Oedipus strivings, which as a rule are expressed by guilt-laden genital mas- 
turbation. An overcoming of these strivings, to be replaced by adult sexuality, 
is the prerequisite for normality, whereas an unconscious clinging to the Oedipus 
tendencies characterizes the neurotic mind. * 

In individual cases, “love for the parent of the opposite sex” and “death wishes 
against the parent of the same sex” may mean various things, the special form 
of which depends again on constitution and experience. Investigating the forma- 
tive experiences, we find a variability not easy to survey. Not only do the person- 
alities of the parents make a lot of difference, but also the conceptions love and 
death vary from child to child. Love is built up of many components, and the 
relative accent on the different components may vary greatly; death may be 
thought of in many ways; a death wish may even be sadistically sexualized and';, 
thus simultaneously give expression to the negative Oedipus complex (418, 
828). 

There is no perception that does not immediately enter into emotional con- 
nections. Thus all experiences participate in determining the special form of the 
Oedipus complex, the experiences at the time of the phallic phase as well as the 
previous ones which may color the Oedipus complex pregenitally through fixa- 
tions. Unique traumatic experiences are as important as chronic influences. 

Traumatic experiences, especially stressed by psychoanalysis from its very in- 
ception, frequently are the decisive factors if the Oedipus complex has not been 
surmounted in a normal way. In talking about genitab strivings, genital factors 
should be considered first- By seduction children's genitality may be aroused 
prematurely, and the intensity of the excitement which was stimulated by ex- 
ternal factors may be beyond the child’s power of control; this creates traumatic 
states which connect the realms of “genitality” and “threat” with each other. 
Anything that increases fears and thus increases sexual repressions causes dis- 



92 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


turbances in the subsequent overcoming of the Oedipus complex. In this way 
threats and all experiences that subjectively signify threats become effective, like 
accidents, injuries, deaths, and the sudden and unexpected sight of adult geni- 
tals. By means of displacement, pregenital experiences may have the same effects 
as genital ones, especially sudden oral and anal frustrations. Especially important 
for the forming of the Oedipus complex is everything the child learns or thinks 
about the parents’ sexual life, the more so if it is experienced suddenly. Often 
combinations of real experiences and wrong interpretations arc decisive. Here 
the realm of the sadistic perception of sexuality must be mentioned. A so-called 
primal scene (599), that is, the observation of sexual scenes between adults (be- 
tween the parents) by the child, simultaneously creates a high degree of sexual 
excitement — the nature of which varies according to the child’s age — and the 
impression that sexuality is dangerous. This impression is caused by the fact that 
the quantity of excitement is beyond the child’s capacity to discharge and is 
therefore experienced as traumatically painful; the child may also sadistically 
misinterpret what he perceives, or the sight of adult genitals may give rise to a 
castration fear. The subjective content, the degree and time of the effect of a pri- 
mal scene vary according to the details of the scene perceived. External circum- 
stances and individual factors determine what the child actually becomes aware 
of, what he surmises and how he incorporates into previous mental experience 
what he has seen and surmised, and whether this incorporation and elaboration 
occur at the moment of viewing the scene or afterward (cf, 7, 1166). 

Instead of a primal scene all kinds of primal-scene substitutes may have been 
experienced: observations of animals, of nude adults, and even of scenes that 
objectively are entirely nonsexual but that are subjectively experienced as sexual. 
The effectiveness of such scenes is greater if other objectively harmless experi- 
ences readily facilitate a transference of what had been witnessed to the parents. 
Arguments between the parents are often equated with sexual scenes by chil- 
^ ^ dren, and thus create a sadistic idea of sexuality. 

Whether or not the sight of the genitals of adult persons creates morbid fear 
in children will depend on the whole previous history of the child, that is, on the 
psychic connections into which the new experience enters (1273). 

Freud has called the infantile idea of observing the parents during intercourse 
a primal fantasy which, if not actually experienced, will in all probability be 
produced in fantasy, the child utilizing all the hints reality offers him (59^)* 
Certainly the effects of such a fantasy can never be the same as the effects of a real 
experience. 

( Another important typical traumatic event is the birth of a sibling. This may 
ffl^bc experienced as a sudden disturbance of Oedipus gratifications because the 
( mother’s care must now be shared with somebody else; or perceptions and spccu- 



93 


DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 

lations about pregnancy and birth may increase sexual curiosity and sexual anxi- 
eties. Both may result in a tendency toward regression into babyhood. 

Concerning chronic influences, a child’s reactions and wishes toward the par- 
ents depend on their behavior and personalities. Unusual behavior will provoke 
unusual reactions. This is to be seen in the family anamnesis of the average neu- 
rotic. Neurotic parents bring up neurotic children, and the children’s Oedipus 
complex reflects the parents’ unsolved Oedipus complex. Very often the mother 
loves the son and the father loves the daughter. The parents’ unconscious sexual 
love for their children is greater when their real sexual satisfaction, due to ex- 
ternal circumstances or to their own neuroses, is insufficient. This love is felt by 
the children unconsciously as a sexual temptation, increasing their Oedipus 
complex; and sometimes it is even unconsciously felt by the parents, who then 
make up for it by sudden threats or frustrations, so that frequently the same 
children are excited and then frustrated by the same parents. 

The ideal Oedipus complex reflects a triangle situation. Actually the Oedipus 
complex is most outspoken in only children {195, 637, 1116, 1339). Special forms 
of the Oedipus complex are created where more or less than three persons arc 
present. Within the frame of the family, brothers and sisters represent persons 
who from the standpoint of the Oedipus strivings are superfluous. First of all, 
they arc objects of jealousy (1039); individual circumstances determine whether 
their presence increases the unconscious hate toward the parent of the same sex 
or decreases it by means of diversion (827) . But siblings may also serve as objects 
for the transference of love, especially older ones or those who arc only a little 
younger, so that the world has never been experienced without them. If there arc 
several older brothers or sisters, wc may see “doubles of the Oedipus complex”; 
what is experienced with the parents is experienced with the older brother and 
sister a second time. This may have a relieving effect, but may also create new 
conflicts, 

A patient with several older brothers had the following dream: ‘T return home 
with my mother after a walk and find that a gang of robbers has meanwhile taken 
possession of our home.” The robbers stood for his brothers, with whom he had 
to share his mother again after returning from their walk. 

Younger siblings, who usually are felt as competitors, may also be looked upon | 
as one’s Wn children,, especially if the difference of age is great, and thus cither ' 
stimulate the Oedipus complex (for example, in girls they may not only create^ 
the jealous idea “Father [or mother] will love the baby instead of me” but also' 
the idea “Father gave mother the baby instead of me”) or decrease the Oedipus 
wishes by a substitute fulfillment. 

The counterpart, the Oedipus complex with too few participants, is developed 
in children who grow up cither wiA only one parent Dr without any parents. 



94 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

When one parent has died or left the family, the child’s development will be de- 
cisively affected by whether pr not the child has known this parent at all, whether 
or not there are stepparents, when and under what circumstances they entered 
the family, and by the behavior and the attitudes of the remaining parent (i68, 
355»76o)- 

Even children who have not known the missing parent are aware that such 
a parent once existed, that other children live with their father and mother. They 
therefore have a tendency to feel themselves exceptions, privileged to ask for 
certain compensations. In general the following can be stated. If the parent of 
the same sex has died, this is felt as a fulfillment of the Oedipus wish, and thus 
creates intense feelings of guilt. If the parent of the opposite sex has died, the 
frustrated Oedipus love most often creates a fantastic idealization of the deceased. 
The details depend on when and how the child became aware of the death. 
Three consequences seem especially important. First, an increased attachment 
to the remaining parent; the character of this attachment is determined by this 
parent’s attachment to the child, and is usually of an ambivalent nature (355). 
Second, a frequent and intense unconscious connection between the ideas of sex- 
uality and death, the two being connected by tl^e conception of “secrets of the 
adults”; this may create an intense sexual fear, due to the idea that sexual ful- 
fillment may bring death, or even a masochistic trend in which dying (reunion 
with the dead parent) may become a sexual goal. Third, a mourning person re- 
gresses to the oral- phase; if this takes place at an early age, it implies permanent 
effects in the structure of the Oedipus complex and character; the Oedipus love 
as well as all later object relations are interwoven with identifications. The sec- 
ond and third points also hold true in connection with the early experience of 
the death of a sibling (1325). 

A woman patient was afraid of marriage. Her mother had died when she was 
five years old. The patient had developed the fantasy that this death in some way 
had been due to childbirth or sexuality. As a punishment for the Oedipus grati- 
fication which she had felt at her mother’s death, she now expected that she would 
have to endure the same fate if she married. 

This is somewhat similar to a patient who as a boy reacted to his mother’s death 
with anxiety and hypochondriasis. He had identified himself with the mother, 
and now was afraid that sexual satisfaction with the father might kill him as, in 
his fantasy, it had killed his mother. Here the condensation of the sexual secret 
with the secret of death was especially clear, because it colored the castration anx- 
iety, shaping it into a fear that things might disappear. 

A woman patient whose father had died when she was a baby later had a tend- 
ency to hate everybody: men because none of them were like her father who on 
account of his death had become idealized; women because her mother had taken 
the father for herself, letting him die before the daughter had had any oppor- 
tunity to enjoy him. 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 95 

In the case of the boy, if the father is missing (or “weak”) this might create 
a predisposition toward femininity, because children identify more with the 
parent who is regarded as the source of the decisive frustrations. 

Conflicts between the parents, divorce, and separation may have similar effects. 
If the children themselves are the subject of parental arguments, this circum- 
stance easily creates an intensification of the complete Oedipus complex and a 
fixation on narcissism which makes them expect that everybody will feel the 
same exaggerated interest in them that the parents have shown, an expectation 
doomed to disappointment. 

The parents of a chronically depressed and generally inhibited woman patient 
had been divorced when she was only a year old. She had never seen her father. 

Her Oedipus complex became centered around the following fantasy: Father 
did not like to live with mother; she was not worthy of him. I am different; one 
day he will come to take me with him.” He did not come. This frustration 
aroused an intense hatred. The patient’s depression represented a turning of this 
hatred against her own person. Her depressive loss of self-esteem meant: I also 
am not worthy of being loved by my idealized father.” 

Unusual behavior on the part of the parents creates unusual Oedjpus com- 
plexes on the part of the children. Unusual behavior again means unusual indul- 
gence, unusual frustrations, or both. Unusual spoiling necessarily causes unusual 
frustrations, because spoiled children have not learned to take frustrations and 
therefore experience slight frustrations as severe ones. Planned educational meas- 
ures are of less importance than the unintentional, natural, everyday behavior of 
the parents (1458). Two factors may be pointed out as especially significant. 
First, the mother’s attitude toward the child’s sex: some mothers wish for a son I 
and make their daughters feel this, Second, the parents’ attitudes toward each 
other, for these attitudes mold the child’s ideas about sexuality. 

Thus the family morals influence the form of the Oedipus complex of the chil- 
dren. To what extent a child feels his instinctual impulses to be permissible and 
to what extent naughty depends not only, for example, on whether and how 
his masturbation is prohibited but also, and even more, on the general attitude 
of the parents toward sex, which is constantly manifested by them, with or with- 
out their knowledge. This includes the reaction of the parents to the child’s atti-| 
tudes toward themselves, toward other children, toward masturbation, as well}; 
as their attitudes about weaning and training for cleanliness during the child’s 
oral and anal development. Pregenital fixation gives the subsequent Oedipus^ 
complex an irrevocable prcgcnital cast. Especially worth mentioning arc the 
passive-receptive forms of male Oedipus complexes created by maternal over- i 
protection (1041). Certain types of authoritative fathers by their behavior block 
any possibility of the child’s becoming iadependeat. 



96 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


A patient, forty years of age, with an intense ambivalent fixation upon his 
tyrannic father, having had a cold, received a wire from his father from a distant 
city: “Because of uncertain weather, do not leave house today.” 

There is still one very important factor which today creates different surround- 
ings for different children and which may influence the special form of the Oedi- 
pus complex, namely, the parents’ social position. Most children unconsciously 
equate “socially low” and “instinctual, uninhibited,” and “socially high” and “sub- 
linaated, inhibited.” If a person from a well-to-do home feels especially attracted 
to those of a lower social level, analysis frequently reveals not only a longing for 
reassurance against humiliation (castration) through intercourse with equally 
“humiliated” (castrated) persons but also a longing for the prohibited sensuality. 
This may be rationalized as an urge to help improve social conditions. 

Many children, in their Oedipus daydreams, develop fantastic ideas of not 
really being the child of their parents; they dream of being some kind of found- 
ling, an offspring of some family of very different social standing; this may be 
cither a high and especially privileged family or a very poor and low one. Fanta- 
sies of this kind, called by Freud “family romance” (552), may serve various pur- 
poses : narcissistic pride, stubbornness, revenge on the parents, and hope for future 
gratifications. 

However, unconscious fantasies about social differences do not tell much 
about the ways in which realities, due to social differences, influence the child’s 
Oedipus complex. Actually they do $0 continually because sexual experiences as 
well as sexual frustrations vary according to social patterns. Freud has shown 
this in detail (596), and one needs only to recall, for example, the sexual, aggres- 
sive, and frustrating experiences of slum children to become aware of this. Ex- 
periences connected with the father’s social position certainly shape the children’s 
love or hate, awe or contempt, admiration or pity for him (496). 

The impression nevertheless prevails that the objectively important factor of 
the social standing of the family finds less reflection in the form of the child’s 
Oedipus complex than one might expect. This is rooted in the fact that the same 
set of morals (or even the same uncertainties in regard to morals) is effective in 
different social strata of one and the same society. 

The idea has been suggested of investigating the advantages and disadvantages 
c£ familvY education (which creates Oedipus complexes) by comparing average 
children, ones who have; been brought up in families, with children who have 
grown up outside of any family circle, for example, in institutions. However, 
even institutional children arc not uninfluenced by the concept of family. They 
learn sooner or later that the institution of the family exists, that other children 
have fathers and mothers, and that in this respect they themselves are at a disad- 
vantage, Thus they, too, have their Oedipus complex. They not only develop 
instinctual bindings of love, hate, jealousy, and so on, toward their educators, 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY ' 97 

but in addition they develop fantasies about father and mother similar to the 
ideas of children reared within a family, only especially formed by their fantas- 
tic character. Their Oedipus complex is characterized by the discrepancy between 
fantasy and reality (250) . What has been said about children who did not know 
one of their parents also holds true for institutional children, and in a double 
sense. If they do not grow up at one certain place but are subject to frequent 
changes of environment, this is not only reflected in typical disturbances of their 
character formation (see pp. 373 f. and 504 £f.), but they never get an opportunity 
to develop any lasting object relationships and their Oedipus complex remains 
pure fantasy. In any sort of permanent community there are always adults who 
serve as substitutes for the parents, but the fact that they were not the real parents 
will reflect itself in the special form of the Oedipus complex. 

The special form of the individual Oedipus complex is shaped by experience. 
But what about the Oedipus complex itself? Is it a biological fact, inherent in 
the human species, or is it a product of the social institution of the family, sub- 
ject to the same changes as this institution.^ 

First it must be said that the difference between biologically determined and 
socially determined is a relative one. We stressed the point that Freud does not 
assume that instincts represent unchangeable patterns: they are rather residuals of 
older environmental influences (588). It was no innate mystical Oedipus com- 
plex that created the family as a place where it might be satisfied; it was the 
family that created the Oedipus complex. In the second place, the answer de- 
pends on the definition of Oedipus complex. The human infant is biologically 
more helpless than other mammalian children. He needs care and love. There- 
fore, he will always ask for love from the nursing and protecting adults around 
him, and develop hate and jealousy of persons who take this love away from 
him. If this is called Oedipus complex, the Oedipus complex is biologically 
founded. 

However, Freud uses this term in a stricter sense: it signifies the combination 
of genital love for the parent of the opposite sex and jealous death wishes for the 
parent of the same sex, a highly integrated combination of emotional attitudes 
which is the climax of the long development of infantile sexuality. In this sense 
the Oedipus complex is undoubtedly a product of family influence. If the in- 
stitution of the family were to change, the pattern of the Oedipus complex 
would necessarily efiange also. It has been shown that societies with family con- 
figurations different from our own actually have different Oedipus complexes 
(iioi). Efforts to explain different family configurations as “repressions of the 
Oedipus complex’* (891) seem to have failed. ■ 

The problem of the origin of the Oedipus complex is thus reduced to the 
problem of the origin of the family, an interesting and still unsolved chapter, 
which lies beyond the province of a theory of neurosis. Freud postulated a hypoth- 



9^ THE PSYCHOA.NA.LYTIC THEORY OF NEUROSIS 

esis about the phylogenetic origin of the Oedipus complex in some prehistoric 
period when mankind was organized in hordes, led by a chief who one day was 
killed and eaten by his sons, this incorporation inaugurating the first “remorse” 
and inhibition (579). This is not the place to discuss the fascinating hypothesis 
of Totem and Taboo. The hypothesis does not alter the fact that the sexual con- 
flicts of children would be different if they did not live together with their par- 
ents and a few brothers and sisters, exposed to the typical family conflicts of 
sexual excitation and frustration. Different environments provoke different re- 
actions. 

Any child at the height of the Oedipus complex must experience disappoint- 
ments and narcissistic injuries; the competitor is a grownup and this gives him 
advantages and privileges. These narcissistic injuries are reacted to in very differ- 
ent ways by different children, depending on their constitution, the concrete 
ways in which the injuries are experienced, and all earlier experiences. Every 
child longs to be adult and plays “adult.” 

However, being a child has advantages, too. Whenever a child is afraid of his 
own emotions and of the implacability of erotic and aggressive impulses, he may 
take refuge in the attitude: “All this is not too serious because I am still a child,” 
and in the receptive longing for external help. 

Both the longing to be adult (if contradicted by guilt feelings) and the feeling 
of being protected as long as one still is a child cause fixations and subsequently 
make ipany neurotics behave and feel as if they still were children at the phallic 
phase. 

A patient who was a successful doctor of many years* practice found out in his 
analysis that whenever a pharmacist filled a prescription he had written, he felt 
in amazement: “The pharmacist, a grown-up man, actually does this work for 
no other reason except that I, a child, have written a prescription!” 


TYPES OF OBJECT CHOICE 

It would be wrong to imagine that in childhood there are no other love objects 
than the parent of the opposite sex. Also siblings, uncles, aunts, grandparents 
(458, 877), friends and acquaintances of the parents may be of decisive influence. 
Many children experience love affairs of a sort with other children of' the same 
or opposite sex or with adults. Probably more such affairs between children 
would occur if education did not aim at prohibiting them. Concerning the mech- 
anisms of object choice, Freud distinguished between the anaclitic type of choice 
— in which an object is chosen because it provokes associations about another 
original object of the past, usually the parent of the opposite sex, sometimes the 
parent of the same sex, siblings, or other persons from the infantile environ- 
ment-^and the narcissistic type of choice, in which an object is chosen because 



99 


DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 

it represents some characteristic of the person’s own personality (585). Both 
types, the anaclitic and the narcissistic, may operate in {a) a positive way: the 
object chosen is similar to the past object or to one’s own ego; in (b) a negative 
way: the object chosen is the opposite of the past object or of one’s own ego; or 
in (c) the ideal way: the object chosen represents what one once wished the past 
object or one’s own ego might be (585). 

THE PROBLEM OF FEMALE CASTRATION FEAR 

In boys, castration anxiety eventually makes the suppression of the Oedipus 
complex necessary. In girls, there seems to be no castration anxiety that could 
be considered a dynamic force. The idea of having lost an organ cannot condi- 
tion the same restrictions of instinct as the idea that one might lose an organ by 
instinctual activity. True, many women, after their disappointment, have un- 
consciously built up the fantasy of possessing a penis (502) . But an anxiety con- 
cerning a merely fantasied organ cannot have the same dynamic effect as a threat 
against a real organ. 

It is not easy to answer the question about castration anxiety in women (1240). 
First, it can be asserted that the Oedipus complex in women actually is not com- 
bated to the same degree and with the same decisiveness as it is in men. There 
are many more women who all their life long remain bound to their father or 
to father figures, or in some way betray the relationship of their love object to 
their father, than there are men who have not overcome their mother fixation 
(1496). Second, analysis shows that other and older fears, above all the fear over 
loss of love, are stronger in women and in many ways take over the role that 
castration anxiety plays in men. Third, the fear that the state of being castrated, 
thought of as an outcome of a forbidden activity, might be found out often limits 
the girl’s sexual expressions considerably; the idea of having destroyed one’s 
own body is often encountered, as is that of having lost all possibility of bearing 
children, or at least of having healthy children, and other anxieties which antici- 
pate that the disgrace is found out. Fourth, there arc anxieties about anticipated 
retaliatory genital injuries which replace castration fear. Just as animistic mis- 
understandings determine unreal pregcnital anxieties, so they also determine 
fantastic genital anxieties. Girls often do not know that they have a preformed 
hollow organ in their vagina, and this explains the fantastic fear that their geni- 
tal longing to be penetrated by the father’s organ may lead to bodily injury. 
Despite all this, the analysis of some women still reveals an unconscious fear 
that an organ will be cut off as a punishment for sexual practices. 

An operation on the thumb had been undergone in childhood in the case of a 
woman in whom this anxiety was very marked. This real threat of amputation 
was then displaced to the fantasied penis. 



100 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


Preanalytic authors (for example Wedekind) and more recently Fromm have 
emphasized the point that differences in the dominant anxieties of the sexes are 
partly due to the physiological differences in the performance of sexual inter- 
course (655). The man needs an erection to perform the act; the woman needs 
no corresponding change in her own body (she is capable of performing the act 
even without enjoyment) but is dependent on the man’s erection. Thus the 
man’s fear is a fear of impotence or failure; the woman’s fear is a fear of being 
left alone or of loss of love. 

No doubt this physiological difference contributes to the prevalent roles of 
castration fear or fear over loss of love in man and woman respectively. However, 
this cannot be more than a relatively late secondary contribution. The relative 
preponderance of the respective fears is established in childhood, long before the 
first experiences in sexual intercourse. 

The change of object is one factor that complicates the development of women 
in comparison to men. A second factor is the double nature of female genital 
sexuality. There is no doubt that the “prostate sexuality’’ of men, which is so 
closely connected with anal and urethral eroticism, does not play as significant 
a role as does clitoris sexuality. However, it should not be forgotten that not only 
these physiological differences are responsible for a greater proclivity toward the 
development of neuroses in women; there are also— and this is of greater impor- 
tance-cultural and social differences in the upbringing of the sexes as related to 
instincts. 


SUMMARY 

Abraham summarized the history of libido development by a diagrammatic 
table (26) which is presented here with slight modifications and an anticipatory 
additional column, Dominant Point of Fixation. The warnings Abraham ex- 
pressed when publishing this table must also be repeated: “The table is compara- 
ble to the timetable of an apress train, in which only a few of the most important 
stations are enumerated. What is situated between them necessarily remains dis- 
regarded. It must also be mentioned that the stages which in the main columns 
arc recorded on the same level do not necessarily coincide.” 



DEVELOPMENT OF INSTINCTS, INFANTILE SEXUALITY 


lOI 


Stages of Libidinal 

Stages in Development 

Organization 

of Object Love 

I. Early oral (suck- 

Autocroticism (no ob- 

ing) stage 

ject, preambivalent) 

2. Late oral-sadistic 

' Narcissism: total incor- 

(cannibalistic) 

poration of the object 

stage 


3. Early anal-sadistic 

Partial love with incor- 

stage ^ 

.t, - 

poration 

IS 

4. Late anal-sadistic ^ 

Partial love 

stage 


5. Early genital (phal- 

Object love, limited by 

lic) stage 

the predominant castra- 


. tion complex 

6. Final genital stage 

Love (postambivalcnt) 


Dominant Point 
of Fixation in 

Certain types of schizo- 
phrenia (stupor) 

Manic-depressive disor- 
ders (addiction, morbid 
impulses) 

Paranoia, certain pre- 
genital conversion neu- 
roses 

Compulsion neurosis, 
other prcgcnital con- 
version neuroses 

Hysteria 


Normality 



Chapter VI 

LATER PHASES OF DEVELOPMENT: THE 
SUPEREGO 

EARLY STAGES OF THE SUFEREGO 

The fear of punishment and the fear of losing the parents’ affection are different 
from other anxieties motivating defense. While other dangers demand cessation 
of the dangerous activity unconditionally, in the case of these fears the activity 
may be continued in secret or the child may pretend he feels “bad” in situations 
where he actually feels “good.” (Ferenczi once said in a lecture on this subject; 
“And out of this lie morality came into existence.”) 

An important step in further maturation is accomplished when prohibitions 
set up by the parents remain effective even in their absence. Now a constant 
watchman has been instituted in the mind, who signals the approach of possible 
situations or behavior that might result in the loss of the mother’s affection, or 
the approach of an occasion to earn the reward of the mother’s affection. This 
watchman fulfills the essential function of the ego: to anticipate the probable 
reactions of the external world to one’s behavior. A portion of the ego has become 
an “inner mother,” threatening a possible withdrawal of affection. 

This internalization of the mother takes place through an act of introjection. 
Introjection is the first instinctual aim directed toward objects; subsequently it 
is also used as an expression of hostility because it is capable of bringing about 
the disappearance of objects; finally it may regressively replace more differen- 
tiated object relations. As an attempt at defense against objects, introjection fre- 
quently fails, for the fear of the external object may still continue as a fear of the 
introjected object. 

The introjection of the parents’ prohibitions brings about an adjusting altera- 
tion within the ego, Alterations of this kind are the' forerunners of the superego, 
which Ferenczi has designated as sphincter morals (505). 

This term stresses the importance of training for cleanliness in the development 
of this “preconscicnce.’^ When asked to evacuate the bowels under certain condi- 
tions only, the child experiences the conflict between “should” and “would like 
to.” The intensity of the impulses to be suppressed and the feelings toward the 
adult who asks for this suppression determine the outcome. 

Originally the child certainly had the wish to do the things the parents do; 
his aim was an identification with the parents’ activities, not with their prohibi- 
tions. The standards and ideals of the parents are an essential part of their per- 
sonality. If children want to identify themselves with the parents, they also want 
to identify with their standards and ideals. Prohibitions are accepted as a part of 



LATER PHASES OF DEVELOPMENT I THE SUPEREGO 

living up to these standards and ideals. The striving for the reward of feeling 
oneself to be similar to the parents facilitates the acceptance of prohibitions. The 
actual identification with the prohibitions becomes a displacement substitute for 
the intended identification with the parents’ activities. 

It is strange that the forces opposing instinctual impulses frequently have the 
stormy and irrational character of instincts themselves. This is most clearly dis- 
cernible in the phenomenon of moral masochism; but the same thing can be 
observed in every normal guilt feeling, with its impulsive demand for a chance 
to make good, and in every analysis in the instinct-ridden character resistances. 
Freud, in his book T he Ego and the Id, raised the question as to the instinctual 
characteristics of the anti-instinct forces and answered: the anti-instinct forces 
have an instinctual character because they are derivatives of instincts (608) . The 
instinctual attitudes of the children toward their parents are turned into forces 
hostile to the instincts by an intr ejection of the parents. Thus through the influ- 
ence of the external world instinctual impulses have been transformed into anti- 
instinctual impulses. 

“Internalized parental prohibitions,” the forerunners of the superego, are very) 
strong in so far as they threaten the child with terrible punishment, the ideas of 
which are created by the aforementioned misapprehension; but they are weak 
in so far as they may be easily disobeyed or circumvented whenever no one is 
looking or when some other circumstance seems to permit something previously 
forbidden. The introjected objects can be easily warded off by a new projection, 
and the functions of the forerunners of the superego can be again shifted to per- 
sons in the external world (1266). Policemen or bogeymen represent these “ex- 
ternalized pre-superegos.” The child fluctuates between giving in to his impulses 
and suppressing them; there is as yet no unified organized character in the pro- 
hibitions. At any rate, it is a situation where under the influence of the external 
world one portion of instinctual energy is utilized for suppressing other instinc- 
tual energies; and this change of direction is produced by an introjection. 


THE ESTABLISHMENT OF THE SUPEREGO 

Now the problem of how the Oedipus complex is normally resolved may be 
taken up again. The answer is: the object relationships of the Oedipus complex 
are regressively replaced by identifications (608). The introjection of the objects 
of the Oedipus complex furthers the development of the ego and complicates 
it in a decisive way. The frustration of the Oedipus complex causes a regression 
from more differentiated types of object relationships to introjection and orality, 
and the sexual longing for an object is replaced by an asexual alteration within 
the organization of the ego. 

The identifications that resolve the Oedipus complex arc, of course, not com- 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 

plete ones. They replace the sexual and hostile impulses toward the parents (at 
least the greater part of them) ; a tender object relationship with inhibited aims, 
however, continues along with the identification. That part of the ego that was 
altered by identification, “the introjected parents,” cannot immediately fuse 
with the rest of the ego, for the objects introduced into the ego are too magnifi- 
cent, and the distance between them and the ego feeling of the child is too great. 
The newly introjected objects become combined with the parental introjects 
already present in the form of the previously described forerunners of the super- 
ego. In describing this phase, Freud states: “The broad general outcome of the 
sexual phase governed by the Oedipus complex may, therefore, be taken to be 
the forming of a precipitate in the ego. . . . This modification of the ego retains 
its special position*,, it stands in contrast to the other constituents of the ego in 
the form of a superego” (608). 

The ego “borrows” from its strong parents the strength that enables it to sup- 
press the Oedipus complex. In this way the resolution of the Oedipus complex 
brings about the marked and decisive “step within the ego” (606), which is so 
important for subsequent ego development and which by its organization is dif- 
ferentiated from its forerunner — the superego. 

The concept of the superego opens up a flood of problems that are often dis- 
cussed but in no way entirely solved {cf. 37, 232, 348, 775, 781, 782, 835, 838, 843, 
893, 895, 1175, 1179, 1196, 1287, 1289, 1333, 1379, 1567, 1602). Here it will suffice 
to sketch a few of these problems. 

If the superego were simply an identification with the frustrating object of 
the Oedipus complex, then one would expect that the boy would develop a 
“motherly” superego and the girl a “fatherly’* one. This is not the case. It is true 
that in accordance with the “completeness” of the Oedipus complex, everyone 
bears features of both parents in his superego. Under our cultural conditions, 
however, generally for both sexes the fatherly superego is decisive; in women, 
moreover, a motherly superego is effective as a positive ego ideal. Men who, 
contrary to the rule, have a pronounced motherly superego have regularly had 
a dotrxinant mother (658, 1041, 1266), The outstanding identification takes place 
with that parent who was regarded as the source of the decisive frustrations, 
which in a patriarchal family is usually the father but which in exceptional cases 
may be the mother. Thus the substitution of an unattainable object relationship 
by an identification is not a simple matter. Apparently under normal circum- 
stances biological reasons prohibit a boy from developing a too intense identifi- 
cation with a woman, or a girl with a man. The attempts at solving these prob- 
lems have not yet advanced beyond Freud*s formulation: “It would appear that 
in both sexes the relative strength of the masculine and feminine sexual disposi- 
tions is what determines whether the outcome of the Oedipus situation shall be 
an identification with the father or with the mother. This is one of the ways in 



LATER PHASES OF DEVELOPMENT: THE SUPEREGO . 1^5 


which bisexuality takes a hand in the subsequent vicissitudes of the Oedipus 
complex’" (608). ■ j./w. 


THE FUNCTIONS OF THE SUPEREGO 

With the establishment of the superego various mental functions are altered. 
Anxiety changes in part into guilt feelings. It is no longer an external danger, 
loss of love or castration, which is feared, but an inner representative of this dan- 
ger, which threatens from within. The “loss of the superego’s protection” or “the 
inner punishment performed by the superego” is felt as an extremely painful 
decrease in self-esteem and in extreme cases as a feeling of annihilation. It has 
been stated repeatedly that small children need some kind of narcissistic supplies 
for maintaining their equilibrium. The privilege of granting or refusing these 
supplies is now taken over by the superego. The fear of being punished or aban- 
doned by the superego is the fear of annihilation through lack of these supplies 
(see p. 136). 

As long as this fear exists, the ego feels the need to abolish it just as urgently 
as it feels an instinctual drive. The origin of this drive is an example of how the 
origin of instincts may be understood in general: they come about through the 
incorporation of external demands (588). 

The ego behaves toward the superego as it once behaved toward a threatening 
parent whose affection and forgiveness it needed. It develops a need for absolu- 
tion, The need for punishment is a special form of the need for absolution: the 
pain of punishment is accepted or even provoked in the hope that after the pun- 
ishment the greater pain of guilt feelings will cease. Thus the need for punish- 
ment can again be understood as the choice of a lesser evil. Instead of castration] 
a sacrifice is offered in order to obviate castration. The sacrifice is actively under-; 
taken and is less unpleasant than the passive waiting for something to happen. 
However, sometimes things are more complicated. Just as “being beaten by thci 
father” may become a sexual aim in masochists, so, too, may “being beaten by 
the superego” (613) (see pp. 364 and 501 f .) . 

After the superego is established, it decides which drives or needs will be per- 
mitted and which suppressed. The logical judgment of the ego as to whether an 
impulse might bring forth danger is now complicated by illogical guilt feelings. 
The ego now has to respect, besides reality, still another, often irrational, “rep- 
resentative of reality.” 

The superego is the heir of the parents not only aS a source of threats and 
punishments but also as a source of protection and as a provider of reassuring 
love. Being on good or bad terms with one’s superego becomes as important 
as being on good or bad terms with one^s parents previously was. The change 
from parents to superego in this respect is a prerequisite of the individual^ 



ro6 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


independence. Self-esteem is no longer regulated by approval or rejection by 
external objects, but rather by the feeling of having done or not having 
done the right thing. Complying with the superego’s demands brings not only 
relief but also definite feelings of pleasure and security of the same type that chil- 
dren experience from external supplies of love. Refusing this compliance brings 
feelings of guilt and remorse which are .similar to the child’s feelings of being 
not loved any more. 

The same mechanisms of defense which are used against discomfortable af- 
fects in general may also be brought into play against guilt feelings (see p. 136). 

Guilt feelings that accompany the performance of a misdeed and the feelings 
of well-being that come with the fulfilling of an ideal are the normal models for 
the pathological phenomena of depression and mania. 

The fact that self-esteem is dependent upon whether or not ideals are fulfilled 
makes the ways of regulating self-esteem as numerous as ideals are. Ideals are 
created in the child not only by real models to be imitated but also by stories, 
teachings, and dogma; they are transferred by tradition and are culturally and 
socially determined. 

Sometimes attempts have been made to distinguish ego ideals, the patterns 
of what one would like to be, from the superego, which is characterized as a 
threatening, prohibiting, and punishing power. But it was Freud’s insight into 
the origin of the superego that showed how closely interwoven these two aspects 
are (608) . They are as intermingled as were the protecting and threatening pow- 
ers of the parents. Even the ways in which these functions are tied up by “prom- 
ises of protection on condition of obedience” are transferred from the parents to 
the superego. 

Freud was criticized for not having differentiated between ‘Teal” ideals which 
are wholeheartedly accepted by the total personality and “ungenuine” ideals 
which one believes one has to follow because an external or introjected author- 
ity demands it (653) . But even the most genuine ideals have been created by 
' intro jeetion. The difference lies in the commensurability or incommensurability 
of introject and subject, that is, in the previous history of the relationship to the 
objects whose introjcctions formed the ideal. 

The relationship between superego and the external world is based on the fact 
that the superego is derived from the introjection of a piece of the external world; 
it is, therefore, the inner representative of a certain aspect of the external world. 
Since the same is true of the ego, in a certain sense the constitution of the super- 
ego is a duplicate of the constitution of the ego; a second ego, a “super” ego, is 
now formed which, it is true, is limited to the spheres of threat and promise, of 



LATER PHASES OF DEVELOPMENT: THE SUPEREGO 


107 

punishment and reward. The incorporation of this piece of the external world 
occurs relatively late; thus the superego remains that part of the mental appara- 
tus closest to the outside world. Many persons remain influenced in their be- 
havior and self-esteem not only by what they consider correct themselves but 
also by the consideration of what others may think. Superego and objects that 
make demands are not always clearly distinguished. Superego functions may 
easily be reprojected, that is, displaced onto newly appearing authority figures. 
(This occurs especially when, for external or internal reasons, an active mastery 
of the external world becomes impossible.) A clinical confirmation of the exist- 
ence of this close relationship between superego and outside world is found in 
delusions of reference. Superego functions (since they are, in a sense, half ego 
and half external world) are the ones that most readily appear when a patient, 
after experiencing a loss of the objective world, tries to regain it, without being 
fully able to do so {see pp. 431 f.) . 

The fact that the construction of the superego takes place on a higher level 
than the construction of the ego will become evident from the following discus- 
sion. The deepest layer of the ego is formed by sensations from one’s own body; 
kinesthetic (and also olfactory) orientation in general are older than visual orien- 
tation. Visual orientation, however, also occurs very early and prevails in the 
preconscious fantasy type of thinking. The decisive step toward the consolida- 
tion of the conscious part of the ego is taken when the auditory conception of 
words is added to the more archaic orientations. In contradistinction, the sen- 
sations that form the basis of the superego begin with the auditory stimuli of 
words. Parental words of admonition, encouragement, or threat arc incorporated 
by way of the ear. Thus the commands of the superego as a rule are verbalized 
(ii, 608, 628). “The step within the ego” is felt by the child by “hearing the 
inner voice of conscience” (1289) ; accordingly, a person’s relation to language 
is often predominantly governed by superego rules (838). 

The superego is related to the id through its genesis. The most essential objects, 
of the id, the objects of .the Oedipus complex, live on in the superego. This genesis 
explains the urgent, instinctlike, irrational character of many superego strivings,' 
which, in normal development, must be overcome by reasonable judgments of; 
the ego (433). “The superego dips deeply into the id” (608). | 

On the one hand, the superego’s strictness corresponds to the previous real‘ 
strictness of the parents; on the other hand, due to the intimate relations between ‘ 
the superego and the id, it depends on the instinctual structure of the child ^ 
(which in turn depends on constitution and previous experiences); a child who; 
unconsciously hates the parents fears retaliation and may experience this retalia-| 
tion from his superego. Thus the strictness of the superego may also express thej 
original hostility of the child toward the parents. 



io8 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


THE “PASSING OF THE OEDIPUS COMPLEX" 

The establishment of the superego brings to an end the strivings of the Oedi- 
pus complex and starts the period of latency. The superego, according to Freud, 
is the heir of the Oedipus complex (608, 612) . 

It is now understandable how it comes about that the Oedipus complex is the 
. normal climax of infantile sexual development as well as the basis of all neu- 
roses : the presence of Oedipus strivings is normal at a certain age but patho- 
logical at any other. The neurosis, based on an undue persistence of the Oedipus 
complex, is a retaining of a stage of development that normally should have 
been overcome (618). 

However, wc have evidence to indicate that the statement “a neurotic person 
has retained his Oedipus complex, whereas a normal person has not” oversim- 
plifies matters. The analysis of dreams of normal persons (552) and also of works 
of artists (559, 568) shows that the Oedipus complex is still active in normal 
adults, too. The dreams, it is true, are not a full proof; in the state of sleep old 
childhood situations may be revived which during the day arc perhaps not ac- 
tive at all. Nevertheless it must be admitted that the axiom given above is not 
absolutely correct; the normal adult, too, still has his Oedipus complex, but 
there is a quantitative difference between the normal and the neurotic indi- 
vidual. In any mental development, earlier stages persist to a certain extent be- 
hind the more recent ones and may be revived under special circumstances. The 
normal person has few ‘^troops of occupation” remaining at the position “Oedi- 
pus complex,” to use Freud’s metaphor (596), the majority of his troops having 
marched on. However, under great duress they, too, may retreat, and thus a nor- 
mal person may become neurotic. The person with a neurotic disposition has 
left nearly all his forces at the Oedipus complex; only a few have advanced, and 
at the slightest difficulty they have to go back and rejoin the main force at their 
first stand, the Oedipus complex. Thus the neurotic disposition is not charac- 
terized by the existence of an Oedipus complex but rather by a failure of the 
'passing of the Oedipus complex. 

The way in which this passing takes place (612) is necessarily reflected in the 
later personality. As a rule this occurs differently in each of the sexes. The boy 
^ gives up his sensual and hostile Oedipus wishes because of a castration fear, the 
’intensity of which is due to the hypercathexis of the penis during the phallic 
jj)hasc. The complex, according to Freud, “is smashed to pieces by the shock of 
threatened castration” (612). In girls, however, it is given up because of fear over 
loss of love, because of disappointment, shame, and also fear over physical injury 
(ue p. 99). All of these forces are of a lesser dynamic value than castrat;ion fear; 
thus the passing of the Oedipus complex in girls generally comes about in a 
more gradual and less complete way. Freud was of the opinion that this is the 



LA.TER PHASES OF DEVELOPMENT: THE SUPEREGO 109 

psychological basis for later character differences in the sexes (617; cf. also 843, 
1164). 

If the formation of the superego did not entirely succeed but was limited in 
its extent by a previous repression of the Oedipus strivings, the individual who 
thus retains a disposition for the development of neuroses feels a sense of failure 
over the frustration of his infantile sexuality. The narcissistic hurt aroused 
by this failure forms one of the sources of subsequent neurotic feelings of in- 
feriority (585). 

VICISSITUDES OF THE SUPEREGO 

Identification with the objects of the Oedipus complex is but one example of 
many identifications that occur throughout life, first as a forerunner of any object 
relationship and later coupled with other object relationships and as regressive 
substitutes for them (408). These other identifications may influence the super- 
ego. Whereas early identifications constitute a great part of the ego’s structure, 
some of them, which have been described as the pre-stages of the superego, stand 
out in contrast to the rest of the ego and assume the functions of observation, 
protection, criticism, and punishment. In identifications that occur in later life, 
it makes a considerable difference whether the introject is absorbed by the ego 
or takes the side of the superego. A person’s ideals certainly are not unchange- 
able after he has entered the latency period. It is rather characteristic for normal 
development that ideals and values become more independent of the infantile 
models when the libidinal tics to the family are abandoned. Everybody experi- 
ences the dethronement of the parents; normal persons experience it more 
gradually, neurotic ones often more suddenly and with fear or triumph. Other 
persons who serve as models, or certain ideas, may become introjected into the 
superego and modify its content. 

The adjustment of a newly acquired introject of this sort with the superego 
often gives rise to complications- If the new ideas bring but a new comment or a 
slight modification of old ideals, the situation is not difficult. Sometimes, how- 
ever, internal or external circumstances may create “parasites of the superego*’ 
which usurp the functions of the superego for a varying length of time (603) . 
This occurs, for example, under hypnosis (1235) or under the influence of mass 
suggestion (606). Extremely violent conflicts between an established superego 
and new introjects are found as the unconscious basis of depression (^see pp, 

393 ff-)- 

Reprojcction of the superego onto external persons occurs frequently and in 
different forms. Certainly neither a belief in “ideal models” nor a certain degree 
of “social fear” (need for approval by others and fear of rejection) is necessarily 
pathological. If various persons take the same object as a representative of their 
superego, this circumstance makes them identify with one another, the basic 



110 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


mechanism of group formation (606) . The belief in authority in general is always 
due to a projection of superego qualities (651). Other forms of reprojection of 
the superego are pathological — for example, projections that are carried out in 
the course of the ego’s struggle against the superego in order to eradicate guilt 
feelings {see pp. 293 f. and 496 ff.). 

To a certain degree the automatic and strict functioning of a rigid superego 
in normal persons is later replaced by a reasonable judgment of the real results 
of one's prospective actions. 

THE LATENCY PERIOD 

The influence of the superego first manifests itself typically after the passing 
of the Oedipus complex (612) as a cessation or as a decrease of masturbatory 
activities and of instinctual interests in general. Changes of partial instincts 
through inhibitions of their aims, sublimations of various kinds, and often 
reaction formations manifest themselves. The character of the person, that is, his 
habitual manner of handling external and internal demands, becomes consol- 
idated during this period (63, 555, 800). 

PUBERTY 

The relative equilibrium of the latency period lasts until puberty. Then there 
is a biological intensification of sexual impulses. The ego, developed in the mean- 
while, reacts differently than before, depending upon previous experience. All 
the mental phenomena characteristic of puberty may be regarded as attempts to 
re-establish the disturbed equilibrium. Normal maturation proceeds in such a 
way that upon the attainment of genital primacy the ego accepts sexuality as an 
important component of its personality and learns to adjust to it. 

This is not simple in societies with our cultural conditions. The psychological 
task in puberty is the adaptation of the personality to new conditions which 
have been brought about by physical changes. However, this task of adaptation 
would be less difficult if the new conditions were really entirely new. Actually 
they arc similar to 'the experiences of the period of infantile sexuality and of the 
Oedipus complex. Therefore, the conflicts of these times also reappear. How- 
ever, in the interim they have become more complicated. The relatively pleasant 
equilibrium of the latency period has stabilized certain attitudes hostile to in- 
stincts, which may now increase anxiety and instability. During the latency period 
the instinctual demands themselves have not changed much; but -the ego has. 
It has developed definite patterns of reaction toward external and interijal 
demands. When in adolescence the ego comes into conflict with instinctual 
drives, the situation is different from what it was in childhood. Contradictory 
attitudes come to the fore. Side by side or following one another appear genital 



Ill 


LATER PHASES OP DEVELOPMENT: THE SUPEREGO 

heterosexual impulses, all kinds of infantile sexual behavior, and attitudes of 
extreme asceticism, v^^hich not only try to suppress all sexuality but everything 
pleasant as well. The increased strength of the genital demands has a physio- 
logical basis. The return of infantile sexual impulses is partly due to the fact 
that genital primacy has not yet been completely established, and puberty brings 
with it an increase in total sexuality; in part, however, the return of infantile 
impulses is caused by the child’s fear of the new forms of his drives, which makes 
him regress to the old and more familiar forms. The asceticism of puberty is a 
sign of fear of sexuality and is a defense against it. A similar set of contradictions 
in behavior is characteristic of the psychology of puberty also outside the strictly 
sexual realm. Egoism and altruism, pettiness and generosity, sociability and 
loneliness, cheerfulness and sadness, silly jocularity and overseriousness, intense 
loves and sudden abandonments of these loves, submission and rebellion, mate- 
rialism and idealism, rudeness and tender consideration— all are typical. These 
contradictions can be traced back by analysis to conflicts between the newly 
strengthened drives and anxieties or defensive tendencies. The effectiveness of 
these defensive tendencies is not a sufficient basis for the assumption that the 
ego is primarily hostile to its instincts or basically afraid of them. It is true that 
up to a certain point every unexpected emotional experience, especially if it is 
intense, may have a frightening effect until the ego becomes familiar with the 
new phenomenon and learns to master it. This also holds true for the first 
pollution or the first menstruation. But for the most part the usual fears of new 
instinctual phenomena arc much more intense than the fright over the initial 
incidents themselves would be. During the period of infantile sexuality and 
especially at the time of the suppression of the Oedipus complex, the child 
learned to consider sexual impulses as dangerous. In a society that treated in- 
fantile sexuality differently puberty, too, would assume a different course {1102). 

As a matter of fact, in puberty sexual development seems to set in again just 
at the point at which it was abandoned at the time of the resolution of the Oedipus ■ 
complex. Before the incestuous bindings are resolved, an intensifying of the striv- 
ings of the Oedipus complex regularly occurs. The fears and guilts connected with ' 
the Oedipus complex are primarily responsible for the fact that the ego in puberty 
is often very hostile to the instincts and very afraid of them. If it were possible fi- 
nally to liquidate the Oedipus complex by satisfactory sexual experiences with ■ 
noninccstuous objects, adjustment would be easier. The fact that this is difficult to . 
achieve under present-day conditions leads to the intensification of the Oedipus 
complex and therefore to the intensification of sexual anxieties (1278). The 
prolonging of puberty, that is, the expenditure of so much time and work to 
restore the psychic equilibrium and to accept sexuality as a part of life, is def- 
initely culturally conditioned (128). "Comparative pubertal research” under 
different cultural and social conditions is a sphere of study that has hardly begun. 



II2 


THE PSYCHOANALYTIC THEORY OE NEUROSIS 


These conflicts between drives and anxieties are felt consciously by present- 
day adolescents principally in the form of conflicts around masturbation. The 
heightened genital strivings sooner or later find expression in masturbatory activ- 
ity. Only when the repression of infantile masturbation has been too intense it 
not resumed at puberty. Fears and guilt feelings which originally were con- 
nected with the accompanying Oedipus fantasies are now displaced to the 
masturbatory activity. Adolescent personalities react differently to these fears 
and guilt feelings; they may take sides more with the drive and try to fight the 
anxiety (or the parents representing the prohibition) ; or they may, more fre- 
quently, side with the anxiety and the parents, and try to fight instinctual tempta- 
tions as well as rebellious tendencies. Often they do both successively or even 
simultaneously. Some adolescents fight their consciences by proving to them- 
selves that they arc not worse than others; they congregate on a narcissistic basis 
for the purpose of swapping stories about sexuality, or even for common in- 
stinctual activity; others withdraw, hide their masturbation and their longings 
entirely and feel ostraci2ed and lonesome, unable to participate in the “sexual” 
or “knowing” gatherings of the others. Fixations on the first type of reaction 
, are represented subsequently by “impulsive characters,” and fixations on the 
second subsequently by ^rythrophobics. 

It is probably because of social factors that adolescents frequently prefer to 
meet in homosexual gatherings. In this way they avoid the exciting presence of 
the other sex and at the same time avoid being alone; thus they may find the 
reassurance they are looking for. However, what has been warded off returns, 
and the friendships that were founded in the hope of avoiding sexual object 
relationships assume a sexual character more or less obviously. Occasional homo- 
sexual experiences between adolescents should not be looked upon as pathologi- 
cal so long as they appear as temporary phenomena of adaptation and do not 
result in definite fixations. 

The frequent preference for homosexual objects at this age may be due not 
only to shyness in regard to the other sex (and to cultural tradition) but also 
to the continued narcissistic orientation of the greater part of the object needs 
of that time. 

Some types of modern pubertal reactions have been studied by Anna Freud 
(541), She described the ascetic type already mentioned who suppresses every- 
thing pleasant together with sexuality. Frequently periods of asceticism alternate 
with periods of wild instinctual activity. The increased intellectual, scientific, 
and philosophical interests of this period represent attempts at mastering the 
drives and the connected emotions. Anxiety often provokes partial regressions 
^at puberty. This explains the contradictions in adolescent behavior toward 
‘‘objects. Many relations at this age represent identifications rather than genuine 
j love; and in many ways objects arc used as mere instruments to relieve inner 



LATER PHASES OF DEVELOPMENT! THE SUPEREGO 




tensions, as good or bad examples, as proofs of one’s own abilities, or as reas- 
surances. The “rudeness” sometimes shown by adolescent boys is often meant to 
intimidate others for the purpose of overcoming their own’ anxiety. Objects are 
easily abandoned if they lose their reassuring significance. 

Puberty is overcome, that is, sexuality is worked into the personality, when the 
capacity for full orgasm is attained. Disturbances in this sphere, rooted in pre- 
vious repressions, serve as the basis for neuroses. Persons afraid of the definite- 
ness of adulthood, that is to say, the definiteness of their instinctual demands 
which they feel they must accept when growing up, resent growing up and pro- 
long their puberty. Such prolongation is made easy for them by various cultural 
conditions (128). They may then, at least for a certain time, enjoy dependence 
and the advantages of youth in reality, whereas they anticipate future grandeur 
and independence in fantasy, while not daring to test the reality value of these 
fantasies in the slightest detail. 

In psychoanalytic literature, there is less to be found about the normal course 
of puberty than about infantile sexuality (exceptions: 76, 128, 129, 139, 183, 226, 
255, 256, 541, 555, 643, 678, 800, 836, 888, II 18, 1255, 1624, 1626, 1627). This is ex- 
plicable by the fact that infantile sexuality was discovered by psychoanalysis, 
whereas puberty had been widely studied before. In no way is this period unim- 
portant. It is true that puberty is a “repetition” of the infantile sexual period, and 
only rarely are conflicts encountered in puberty that have not had forerunners 
in infantile sexuality. Nevertheless, experiences in puberty may solve conflicts 
or shift conflicts into a final direction; moreover, they may give older and oscillat- 
ing constellations a final and definitive form. Many neurotics give an impression 
of adolescence. They have not succeeded in getting on good terms with their 
sexuality. Therefore, they continue the behavior patterns of adolescent chil- 
dren, that is, of an age at which it is usually considered normal not to have 
achieved these good terms and to feel life as a provisional state, with “full real- 
ity” still waiting in an indefinite future. 




PART II 


PSYCHOANALYTIC THEORY OF 
NEUROSIS 




A. Traumatic Neuroses ’ 

CHAPTER VII 


Chapter VII 

TRAUMATIC NEUROSES 

THE CONCEPT OF TRAUMA 

The basic function of the mental apparatus is the re-establishmcnt of stability 
after a disturbance by external stimuli. This is achieved first by discharge of the 
excitement aroused, later by its ^‘binding” and by combinations of discharge and 
binding. Whenever the maintenance of a (relative) equilibrium fails, a state of 
emergency arises. Too high an influx of excitement within the given unit of 
time is the simplest type of such an emergency. 

However, the expression “too high” is a relative one; it means beyond the 
capacity of mastery. This capacity depends on constitutional factors as well as 
on all of the individual’s previous experiences. There are stimuli of such over- 
whelming intensity that they have a traumatic effect on anyone; other stimuli 
are harmless for most persons but traumatic for certain types with a readiness to 
become overwhelmed traumatically. Such “weakness” may have a constitutional 
root. It further depends on the mental economics of the person: for a child, the 
disappearance of a beloved person may be a trauma, because the libidinal 
strivings directed toward this person, having lost their aim, overwhelm the 
child; an adult is more subject to traumatic experiences when tired, exhausted, 
or sick. Ajiother decisive difference is whether or not, at the time of the trauma, 
motor reactions are possible; the blocking of external motor activity increases the 
probability of a breakdown, and foxhole waiting is more dangerous than active 
warfare. The most important factor, however, is represented by previous repres- 
sions; those persons are “weak” whose binding capacity is fully taken up by the 
maintenance of earlier repressions. Thus trauma is a relative concept; factors of 
mental economy, dependent on constitution as well as on previous experiences 
and on the actual conditions before and during the trauma, determine what 
degree of excitation overtaxes the individuars capacity. 

The ego may be regarded as having been developed for the purpose of avoiding 
traumatic states. Its sifting and organizing (discharging and binding) of incom- 
ing excitation are facilitated by its ability to anticipate in fantasy what might 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


ii8 

occur, and thus to prepare for the future. Economically, such preparation con- 
sists of making ready amounts of countercathexis for the purpose of binding the 
excitations to come. Events that have not been anticipated are experienced more 
forcefully than those prepared for. Therefore, an incident is likely to have a 
traumatic effect in direct relationship to the unexpectedness with which it occurs. 

Unmastered quantities of excitement, built up by sudden overwhelming 
events as well as by chronic strain, create very painful sensations of tension, and 
set in motion pathological and archaic attempts to master what could not be 
mastered in the usual way. A kind of emergency regime of discharge is created 
(1292), partly as an automatic function against the will and without any partici- 
pation on the part of the ego and partly by the remaining and restored forces 
of the ego. 

The symptoms of traumatic neuroses are {a) blocking of or decrease in various 
ego functions, (b) spells of uncontrollable emotions, especially of anxiety and 
frequently of rage, occasionally even convulsive attacks, {c) sleeplessness or 
severe disturbances of sleep with typical dreams in which the trauma is experi- 
enced again and again; also mental repetitions, during the day, of the traumatic 
situation in whole or in part in the form of fantasies, thoughts, or feelings, 
(d) psychoneurotic secondary complications. 


BLOCKING OF OR DECREASE IN EGO FUNCTIONS 

The blocking of ego functions can be explained as a concentration of all men- 
tal energy available on one task, the building of counterenergies to master the 
intruding overwhelming excitation. The urgency of this task makes all the other 
ego functions relatively unimportant; these functions have to relinquish their 
energies in favor of the emergency task which completely governs the person. 

The blocking of some of the functions, especially of the perceptive and apper- 
ceptive ones, acts simultaneously to prohibit the influx of further excitation. The 
excitation already at hand has to be mastered before new stimuli can be accepted. 
The organism develops different ways of protecting itself against too great a 
quantity of stimulation (Reizsckutz) (605); refusing to accept new stimulation 
is a primitive means of re-establishing such protection after it had been broken 
down by the trauma. 

Among the functions that might be weakened or blocked, because they have 
become relatively unimportant after the trauma, is sexuality. Generally the sex- 
ual interest of traumatic neurotics is diminished, and in male patients temporary 
impotence occurs very frequently (340, 1616). Although this symptom often 
may he due to psychoneurotic complications, it may also be an entirely unspe- 
cific symptom. The sexual energy, like other mental energies, is mobilized for 
the purpose of mastering the intruded excitation and is no more at the disposal 



TRAUMATIC NEUROSES 


II9 

of sexuality. Just as sexual interest generally decreases in sick persons because 
they become narcissistic, so may sexual energy lose its specific character after a 
trauma (340). 

In traumatic neurotics regressive phenomena of all kinds in the realm of the 
instincts as well as of the ego have been described. They are to be looked upon 
as the result of a general loss of differentiation of the higher functions, again for 
the purpose of the overwhelming task, the "‘unspecific’' mastery. Besides, this 
“primitivation” may serve another purpose as well: helpless persons usually 
tend to regress to the times of their childhood, because as children they actually 
were helped by “omnipotent” grownups. Traumatic neurotics sometimes de- 
velop a kind of demonstrative attitude of helplessness and passive dependence 
and show certain oral trends; this is a regression to the more primitive passive- 
receptive type of mastery of the outer world following their failure to succeed 
in an active way. This reaction will be stronger in persons who were inclined 
to this type of mastery even before the trauma: limited in their active abilities, 
from the beginning, they will m(^re quickly go into a traumatic state than per-?' 
sons with a more active ego. 

Ego blocking, represented in fainting as a response to a trauma, is the most 
archaic and primitive “defense mechanism.” In fainting, the organism, which 
has been overwhelmed with too intense stimuli, shuts out the influx of further 
stimuli. The complicated defense mechanisms of the psychoneuroses may be 
looked upon as partial faintings. In fainting, all perception is blocked; in reprcs-|, 
sion, some selected perceptions are blocked {see p. 144). j 


EMOTIONAL SPELLS 

The various emotional spells, too, represent more archaic .and involuntary 
emergency discharges. To a certain extent, they are entirely unspecific; a person 
after suffering a trauma may be restless, hyperkinetic, may tend to cry and 
shout. In part, these reactions are specific and their nature can be explained either 
by the motor and sensory situation at the moment of the trauma or by the pre- 
traumatic history of the person. The fact that the emotional quality of such) 
spells is most often felt as anxiety or rage is important and should be kept inj 
mind. A study of the development of anxiety shows that all later spells of anx^ 
iety represent repetitions of early traumatic states. The objective state of being! 
flgoded with unmastered excitation is subjectively felt as being very painful, 
and the quality of this pain is very similar to anxiety. This is brought about 
partly by the unmastered inner tension itself and partly by involuntary vegeta- 
tive “emergency discharges” (618). Later states of rage, too, are rooted in situa- 
tions of frustrations, that is, in states where an urgent need is not fulfilled and 
the available discharges are not adequate. Thus anxiety and rage in traumatic I 



120 


THE PSYCHOAN.\LYTIC THEORY OF NEUROSIS 


neurotics represeat discharges o£ excitations that were aroused in the traumatic 
situation but could not be discharged sufficiently. Their specific nature, however, 
often can be explained by the emotions felt (or aroused but not felt) during the 
trauma. In this sense the emotional spells belong in the category of “repetition 
symptoms” in traumatic neurotics, to be discussed later. 

The archaic epileptic syndrome probably functions as an emergency outlet 
in certain constitutionally predisposed individuals (917) * 

SLEEP DISTURBANCES AND REPETITION SYMPTOMS 

Sleep presupposes a state of relaxation. An organism flooded with excitation is 
, unable to relax. It is understandable that the unmastered amounts of excitation 
in the traumatic neurotic makes sleeplessness one of his main symptoms. 

The active repetition of the trauma in dreams, which is so torturing to the 
patient, is economically a relief for him nevertheless. The archaic ego, before it 
was able to anticipate the future, mastered the outer world by the active repeti- 
tion of what had been experienced passively. The. repetition dreams of the 
traumatic neurotic represent a regression to this primitive mode of mastery; by 
experiencing again and again what once had to be gone through in the trauma, 
the control may slowly be regained. It brings belated discharge and thus helps to 
get rid of tensions (605). Besides, these dreams make sleep possible in spite of 
the inner tension. 

Repetitions of the trauma are not limited to dreams. They occur also in the 
waking state. In part they are conscious: the patient cannot free himself from 
thinking about the occurrence over and over again. In part they are unconscious: 
the patient experiences spells or makes certain ticlike movements which mani- 
festly have no meaning whatsoever but which in analysis betray themselves* as 
repetitions of movements performed in the traumatic situation, or as movements 
that would have been purposeful in the traumatic situation but were omitted. 
It may occur that the movements do not fit into the precipitating traumatic 
J situation but into some still older and forgotten situation which had been newly 
remobilized by the trauma (1434). 

Whereas an obsessive rumination about the trauma represents an attempt at 
the belated binding of the intruded excitation, the active repetition of what has 
been passively experienced, like the emotional spells and movements, represents 
attempts at belated discharge. If such active repetition is compared to the afore- 
mentioned mobilization of a passive-receptive attitude, it is seen that the same 
goal may be striven for by precisely opposite means. 

A trauma is a situation in which a person’s usual modes of adjustment have 
failed; he then has to find new. and better ways of adaptation* This statement 
docs not differ from what has already been said. Adaptation consists in nothing 



TRAUMATIC NEUROSES 


I2I 


more than a complicated system of bindings and primitive discharges. One 
aspect, it is true, is stressed more when the term adaptation is used, that is, the 
active role of the ego. Actually, when the ego and its modes o£ adaptation fail, 
two things occur: (i) the ego is overwhelmed and symptoms beyond the ego 
occur, which are experienced passively; (2) the ego as soon as possible tries to 
re-establish its control even to the extent of applying more archaic principles of 
mastery— by regressing, if necessary (922). 

Since the ego differentiated itself gradually from the id and there are deep 
archaic layers of the ego still very close to the id, it is not easy to state whether a 
given symptom of a traumatic neurosis occurs because the ego was overwhelmed 
or whether the ego makes an attempt at a new, archaic, and undifferentiated 
type of mastery. The word adaptation stresses the second point of view; actually, 
the concept of traumatic neurosis includes and justifies the first aspect: that not 
only the ego ‘‘adapts” itself, but also that something happened to which the 
organism was not “adapted.” 


PSYCHONEUROTIC COMPLICATIONS 

It is not possible to describe the psychoneurotic complications that occur in 
traumatic neuroses before the psychoneuroses themselves have been studied in 
detail. After having discussed the psychoneuroses, a separate chapter will be 
devoted to neuroses that represent a combination of traumatic and psychogenic 
elements {see pp. 541 ff.) . To complete the picture of the traumatic neuroses, how- 
ever, it is necessary to characterize even at this point certain psychoneurotic 
trends that are never entirely missing in traumatic neuroses. 

Every person has a certain amount of warded-off instinctual energies which 
are kept from being discharged by defensive forces and which try to break 
through nevertheless. As long as a certain stability prevails between the repressed 
impulses striving for discharge and the defensive forces preventing this dis- 
charge, the person may suffer from a certain impoverishment of his personality 
but otherwise remain relatively well. But any disturbance of this equilibrium 
brings the danger of a breaking through of the repressed impulses and the neces- 
sity to develop new and more effective means of defense — in other words, the 
danger of a neurosis (431). Experiences that precipitate neuroses always repre^ 
sent alterations in the earlier, relative equilibrium between warded-off impulses/ 
and warding-off forces {see pp. 454 ff.). ^ 

Freud has pointed out that in the etiology of neuroses the precipitating cause) 
and the neurotic disposition (that is, constitution plus infantile experiences) are ; 
complementary. An individual who as the result of his constitution and infantile ) 
fixation has a neurotic predisposition will respond to even a minor difficulty with 
a reactivation of his infantile conflicts and therefore with a neurosis; an individ- 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 

ual with less predisposition may also develop a neurosis, if his life experiences 
happen to be sufficiently severe. There is an etiological series of cases; at one end 
of the series are cases in which the actual precipitating cause is of no practical 
importance, and at the other, cases in which the specific precipitating cause plays 
a predominant role (596). 

There is no doubt that a certain percentage of what is described as traumatic 
neuroses actually are psychoneuroses that were precipitated by some accident. 
This can be corroborated by the fact that sometimes there is a grotesque dispro- 
portion between the comparative insignificance of the “trauma” and the rather 
severe neurosis it is supposed to have precipitated. The more intense the pre- 
vious repressions and the more unstable the equilibrium in the defense conflicts, 
the quicker an experience will have a traumatic character. Every individual has 
a ‘‘breaking point.” However, in different persons the ease with which this 
point may be reached varies greatly. 

In persons with a neurotic disposition there is not only a quantitative impov- 
erishment of the ego which permits stimuli to provoke traumatic situations; there 
V is also a qualitative sensitization at certain points of “complexes.” Experiences in 
' the realm of the complexes tend to have traumatic effects. (This will become 
clearer in the discussion of psychoneuroses.) 

It would be a paramount task for army induction psychiatry to screen out per- 
sonalities for which the military situation as such is a “complex point.” Ideas of 
“belonging to a great unit,” as well as the provision of food and shelter, the limita- 
tion of personal responsibility, and an environment that almost excludes the other 
sex, have, of course, significance for everybody. The sj^ecific nature of this signifi- 
cance, however, varies enormously. Frequently the military situation involves a 
certain mental “infantilization,” the army and the superiors representing the shel- 
tering but also threatening parents. Some persons may accept this without much 
of a conflict and even be helped by it. Others, however, to whom the infantiliza- 
tion means a remobilization of repressed infantile conflicts, may become sensitized 
and weakened in their capacity for resistance. Still others may, according to their 
childhood experiences, be strengthened and weakened simultaneously or succes- 
sively, or feel more protected under certain conditions, less protected under others; 
for instance, more protected as long as there is no combat, less in combat, or vice 
versa; or more protected in victory, less in defeat. Simmcl explained the typical 
attitude of the soldier as an expectation of parental protection; this expectation 
may give place to a sudden and severe disappointment (1434)* 

Severe traumata that upset the entire economy of the mental energy also of 
necessity upset the equilibrium between the repressed impulses and the repress- 
ing forces. The first type of such a disturbance is a general and unspecific one. 
For the purpose of fulfflling the overwhelming task of a belated mastery of the 
intruding excitation, all differentiated mental functions, including sexuality, 
may be robbed of their specific cathexes; this also holds true for the cathexes that 



TRAUMATIC NEUROSES 


123 

have been bound by conflicts o£ repression. The cathexis o£ the defending forces 
may be mobilized first; this is a general reason why repressed forces make a more 
or less open reappearance after traumata. The picture thus created is that o£ an 
unspecific disintegration of the personality, in which the abolition of differentia- 
tions and the regression toward childish dependence are predominant. 

In a more specific way, latent neurotic dispositions may be mobilized by a 
trauma either (a) by an increase in the anxiety that motivates repression or 
(^) by an increase in the repressed instinctual forces. 

If a person had developed a certain amount of castration anxiety or anxiety 
over loss of love, and subsequently has overcome this anxiety by certain inner 
reassurances (“It is not so bad after all, and probably there is no real castration, 
and I shall not be abandoned for good”), the experience of a trauma is apt to 
upset these reassurances and to remobilize the old anxieties. Persons who, for 
example, have hitherto denied their fears by partial regression to the security 
of primitive narcissism and omnipotence are forced by the trauma to admit that 
they are not omnipotent after all, and the old anxieties reappear. This is espe- 
cially true in one type of anxiety over loss of love. Some persons have the capacity 
for hanging on to the belief that fate will protect them, just as their parents had 
protected them before in their childhood. Such persons experience a trauma as a 
betrayal by fate which refuses to protect them any longer. The frightening idea 
of having lost the protection of a powerful person with superego qualities varies 
in intensity according to the degree to which the subject had already submitted 
to a passive-receptive attitude before experiencing the trauma. This submission 
may have been acute, as in a soldier or sailor in combat, or chronic, as in persons 
whose self-esteem has remained dependent on constant reassurance of being 
protected or loved. The latter are not only inclined especially toward the develop- 
ment of traumatic neuroses but also traumatic neuroses in this personality type 
will be governed more by depressive clinical pictures (1244). 

It was mentioned that chronic stress may have the same effect as a trauma. 
There is one particular kind of chronic stress that has a specific result: Extreme 
frustrations, which make a person feel that he is really abandoned and not cared ' 
for by anybody, or anything, precipitate in adult persons states of apathy that 
are comparable to “primary depressions” in children (see p. 404) or even to the . 
way in which hospitalized infants without mother’s love remain somehow sub-j 
dued. 

The effect of castration anxiety is particularly clear in cases where the traunoa 
has brought the intense danger of physical injury. (However, it is well known 
that traumatic neuroses occur more often in cases that have not suffered real 
injuries.) There are quite a number of postoperative traumatic neuroses, where,] 
for instance, the patient had not been mentally prepared and the operation 



124 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


then regarded as a castration. This actually occurs more frequently after genito- 
urinary operations than after operations involving other parts of the body (514). 

The fact that the castration fear created by an operation increases with the de- 
gree to which the operation has a traumatic effect necessitates a mental hygienic 
preparation of patients before surgical operations. Children especially have to be 
prepared by objective enlightenment about what is going to happen before they 
are operated upon, to avoid serious shocks. 

The degree in which a trauma is experienced as a loss of the protection of 
fate or as castration is dependent, of course, upon the pretraumatic history of the 
patient. The intensity of the unconscious readiness to develop anxieties and the 
ways in which persons have learned to deal with anxieties are decisive. 

What is most characteristic in the reaction to a trauma is that associative con- 
, ncctions are immediately established between the trauma and the infantile con- 
flicts that become activated. Old infantile threats and anxieties suddenly reappear 
and assume a serious character. The trauma may be experienced as a mere repeti- 
tion of other older traumata of childhood. It has been mentioned that sometimes 
the symptoms of spells in traumatic neuroses may reveal themselves as deter- 
mined not by the physical situation in the actual traumatic situation but by the 
physical situation in some forgotten childhood scene. The whole “trauma” may 
have a screening function (686). 

Staudacher studied a war neurosis precipitated by the explosion of a grenade 
in which the patient’s reaction was determined in all its details by a childhood ex- 
perience that took place at the age of three (1472). 

Concerning an increase in the repressed impulses, it seems unlikely that a 
severe trauma should also be felt as a kind of temptation. It is true that in general 
a trauma is frightening and does not bring any instinctual satisfaction or tempta- 
tion. But actually, there are persons whose sexual instinct has undergone a sado- 
masochistic distortion, and who have an immense (conscious or unconscious) 
interest in all dangerous, extraordinary, cruel, and “thrilling” events. The more 
; an interest of this kind is repressed, the more likely it is that a trauma may un- 
1 consciously give the feeling: “Now, my sexual fantasies are becoming real at 
‘ last.” In this sense the trauma may be perceived as a sado-masochistic tempta- 
tion. It is more probable, however, that it is perceived as a mixture of temptation 
and punishment : “What Thave wished for is happening now; and it is happen- 
ing in a terrible way, so that I shall be punished for having wished it,” The 
trauma may signify the breakdown of a counterphobic attitude {see p. 549). 

/ A third type of remobilization of latent conflicts by a trauma is the arousing 
j of old conflicts between the ego and the superego. Even without having discussed 
the nature of these conflicts as yet, it will be conceivable that an ego when experi- 
I cncing a trauma may not only feel “fate the, successor to my parents, is abandon- 



TRAUMATIC NEUROSES 


125 


ing and castrating me” but also ‘'And it serves me right, because I am guilty.” 
This attitude, repeating on an internal level conflicts that originally existed 
between the external world and the ego, turns certain traumatic neuroses into a 
narcissistic affliction. 

All military psychiatrists know the depressive features in traumatic neuroses of 
soldiers whose “buddy” was killed while they themselves were saved. This does 
not necessarily presuppose that they have felt especially ambivalent toward the 
lost comrade. What they feel guilty about is rather that they had hoped that 
if “somebody’s number is up,” it may be another fellow and not they themselves. 

In his discussion of war neuroses, Freud called attention to a fact that com- 
plicates the role played by the superego in traumatic neuroses (603) : the intra- 
psychic representative of fate may consist not only of the genuine superego, which 
has been acquired in childhood, but also be made up of later and more super- 
ficial identifications with various other authorities. Such superficial and passing 
identifications may sometimes be very influential and come into conflict with the 
genuine superego. Freud spoke of these formations as “parasitic doubles of the 
superego,” which for certain periods may usurp the power of the superego. Rado 
has demonstrated that the intrapsychic representation of a hypnotist may be 
considered as a parasitic superego. (It is even a “parasitic double of the ego”) 
(1234). Freud stated that war conditions may create a “war superego” of this 
kind, which not only permits the expression of impulses otherwise forbidden 
but even makes demands that are tempting to the ego because its genuine super- 
ego never permitted such impulses to be brought into action. According to 
Freud, one finds in many war neuroses that a “peace ego” rises in defense against 
a “war superego” (603) . 

Whether or not a sudden influx of unexpected stimulation has a traumatic 
effect depends upon the personality experiencing the event. This concerns the 
actual situation at the moment of the trauma as well as the entire infantile his- 
tory. As to the actual situation, first of all, the state of preparedness is decisive : 
the more preparation, the less likely a trauma. Traumatic neuroses are more 
intense when the trauma encounters an ego exhausted by a long endured stress 
(presupposing that the stress was not a kind of “expectation” of the event, in 
which case is would be a favorable circumstance) (1244). 

As to the specific structure of the personality at the time of the trauma, Simmel 
and Rado showed that it is not only a “war superego”., which in soldiers increases 
the dangers of a “neurotic breakdown”; the whole war situation is psycholog- 
ically characterized by two contradictory features: it demands actions that 
represent instinctual outlets hitherto forbidden; hut simultaneously it frees the 
personality from responsibility and causes a certain rc-establishmcnt of the old 
oral-receptive way of mastering the outer world. The commanding officer has the 



126 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


responsibility and the power; and he is believed to have the duty of and the 
capacity for giving protection. The disappointment is all the greater when this 
expectation fails (1244, 1434). 

Not only arc the commandments and prohibitions of the superego different in 
war from those that were valid in peace, but the “infantilization” in the military 
situation involves many of the superego’s functions being reprojected onto the 
superiors. If the superiors fail in their role of protectors and rewarders, the worst 
has occurred, since the soldier is no longer in the habit of functioning as his own 
superego. The hatred thus mobilized against the nonprotecting father substitute 
may be condemned by the still existing superego and thus create guilt feelings 
and new severe conflicts. 

The infantile history decides the degree of stability of the personality, that is, 
its amount of latent conflicts ready to be mobilized. In general : the more repres- 
sions, the less free energy is at hand to master newly arriving excitations, and the 
greater the readiness for traumatic effects. The fact that the development of a 
traumatic neurosis is contingent upon childhood history justifies the attempts 
to exclude from the armed forces potential victims of traumatic neuroses. 

The fact that the pretraumatic personalities are reflected in traumatic neuroses 
betrays itself in the multiplicity of the clinical pictures, and also in the change of 
the clinical pictures in different cultures and times, analogous to the change of 
the clinical pictures of psychoneuroses in different cultures and times. 

In World War II there are reported many more schizophrenic or schizoid epi- 
sodes of short duration that ended spontaneously than in World War 1 . If reality 
becomes unbearable, the patient breaks with reality. But enough preconscious 
attention remains to re-establish the contact with reality as soon as it becomes 
bearable again. It may be that the recent prevalence of psychotic mechanisms in 
traumatic neuroses corresponds to the prevalence of “character disorders” among 
the psychoneuroscs {s€c p, 447). 

SECONDARY GAINS 

In the traumatic neuroses, secondary gains play an even more important role 
than in the psychoneuroses; these are certain uses the patient can make of his ill- 
ness which have nothing to do with the origin of the neurosis but which may 
attain the utmost practical importance. The symptoms may acquire secondarily 
the significance of a demonstration of one’s own helplessness in order to secure 
I external help such as was available in childhood. The question how to combat 
or to prevent secondary gains often becomes the main problem in treatment. In 
cases where a neurosis has been precipitated by a comparatively minor incident, 
the incident itself is often placed in the foreground by the patient, who in this 
I way succeeds in again repressing the mental conflicts mobilized by it. Obtaior 
I ing financial compensation or fighting for one creates a poor atmosphere for 



TRAUMATIC NEUROSES 


127 


psychotherapy, the more so if the compensation brings not only rational advan- 
tages but has acquired the unconscious meaning o£ love and protecting security 
as well. Yet anyone who has a psychoanalytic understanding of the neurotic 
processes will not equate neurosis to simulation and will not repudiate com- 
pensation altogether. It may be that there is no fundamental solution of the 
question how compensations should be handled that would be equally valid for 
all cases. Perhaps the idea of giving one single compensation at the right time 
may be the best way out. 

Since the course and the special nature of the symptomatology of traumatic 
neuroses are to a great extent dependent upon the “psychoneurotic complica- 
tions” involved, many of their problems will be more easily approachable after 
the discussion of the psychoneuioses. 


PSYCHOANALYSIS IN THE THERAPY OF TRAUMATIC NEUROSES 

In traumatic neuroses, we sec two sets of spontaneous attempts at recovery 
that seem to be actually contradictory: (a) attempts to get distance and rest, to , 
collect energy, as it were, for the task of belated mastery: the stopping of or 
decrease in ego functions and the undoing of differentiations, a withdrawal 
toward a fresh start for the reconstruction of the’ collapsed equilibrium; {b) at-- 
tempts at belated discharges: motor phenomena, emotional spells, repetition phe- 
nomena. The first set could be called the quieting-down method, the second the 
stormy method— both aimed at the same end of belated mastery. 

Therapy can and should imitate both ways. On the one hand the therapist may 
give rest, reassurance, the satisfaction of wishes for passivity and dependency — 
“take-it-easy” suggestions. On the other hand he may give catharsis, the oppor- 
tunity for stormy discharges and for the repeated re-experiencing of the trauma 
and a verbahzation and clarification of the conflicts involved. The second method . 
is, when applicable, a more direct help; the first one becomes necessary when the / 
ego is too frightened, when a working through of the traumatic event is still 
unbearable and would still be too much of a repetition of the traumatic character 
of the experience. Apparently the therapeutic task in traumatic neurosis con- 
sists in finding out which blend of the two methods is necessary in a given case. 
To find the relatively correct amount of catharsis and reassurance is the main 
task of therapy, and it is of compar?itively minor importance by which method 
catharsis as well as reassurance are achieved. While in general it will be better 
to encourage the patient to talk as much as possible about the trauma and to tell 
his experiences over and over again, some patients first need rest and greater dis- 
tance from their experiences before they are capable of abreactions. 

The more a traumatic neurosis has induced a secondary psychoneurosis, the 
more other measures will become necessary. Those are the cases that need psycho- 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


128 

analysis, the prognosis of which will depend on the nature of the induced psycho- 
neurosis. Cases in which the “traumatic” change represents a hysterical reaction 
arc as amenable to psychoanalysis as hysterias are. Frequently, as has been 
mentioned, pronounced narcissistic admixtures are evident, which makes the 
prognosis of psychoanalysis more doubtful. 

Rardiner described cases in which traumatic neuroses did not tend toward a 
spontaneous cure but rather toward the development of lasting defects of the 
personality (922). In these cases, the blocking of or decrease in ego functions, 
characteristic for every traumatic neurosis, created a lasting decrease in percep- 
tion, judgment, and interest in the external world, a readiness to withdraw from 
any contact with reality, probably corresponding to a fear of repetition of the 
trauma. The resulting picture is that of a very restricted personality living a sim- 
ple life on a low level, comparable to certain psychotics or to personalities that 
have overcome a psychosis with scars in their ego. Several cases of this irrepara- 
ble type have been described (1143). Probably this unfavorable development is 
due to constitutional or psychoneurotic complications of a narcissistic nature. In 
such cases, therefore, psychoanalysis, too, may become difficult. Early treatment 
is indicated, before the alterations created by the trauma are imbedded too deeply 
into the personality. 

■ ' The traumatic neuroses offer a unique opportunity to study the fact that the 
|cgo is an apparatus developed for the purpose of overcoming past traumata and 
.‘Tor avoiding future traumata; traumatic neuroses represent an insufhciency of 
‘this basic function of the ego. 



B. Psychoneuroses, the Neurotic Conflict 

CHAPTERS YII I-X 


Chapter VIII 

THE MOTIVES OF DEFENSE 

WHAT IS A NEUROTIC CONFLICT? 

The psychoneuroses arc based on the neurotic conflict. The conflict results in the 
blocking of necessary discharges and in this way creates a state of being dammed 
up. This state gradually gives rise to a relative insufficiency of the ego’s capacity 
to master excitation. The precipitating factors of psychoncuroses must be looked 
upon as relative traumata; stimuli which, were it not for the state of being, 
dammed up, would have been mastered without difficulty, now create a relative 
insufficiency {see pp. 454!!.), 

The neurotic conflict, by definition, is one between a tendency striving for ' 
discharge and another tendency that tries to prevent this discharge. The intensity " 
of the tendency toward discharge, it has been stated, depends not only upon the 
nature of the stimulus but, even more, upon the physicochemical state of the 
organism. In general it is permissible to equate the tendencies that strive for dis- 
charge with drives (“instinctual impulses”) ; the sieving of drives, that is, the 
decision as to whether or not their discharge should be permitted, has been 
defined as a function of the ego. Therefore, the general formulation would be: ' 
the neurotic conflict ta\€s place between drives, that is, the id and the ego (608, * 
611). 


ARE NEUROTIC CONFLICTS BETWEEN OPPOSING INSTINCTS POSSIBLE? 

Is this formula valid for all neurotic conflicts.? Or would it be conceivable for 
a neurotic conflict to take place between two instinctual demands with contra- 
dictory aims.? Certain clinical facts seem to prove, for example, that homosexual-) 
ity may repress heterosexual impulses or that sadism may repress masochism) 
(42, 601). 

However, if the history of conflicts of this type is investigated it is regularly 
found that the apparent conflict between instincts merely covers or represents 
another conflict between an undesirable instina and some fear or guilt feeling^ 



130 


THE psychoanalytic THEORY OF NEUROSIS 


that objects. This objecting force succeeded in increasing the intensity of some 
other drive — the aim of which was opposed to that of the original objectionable 
drive— because this increase helped strengthen the intended defense. An in- 
stinctual conflict at the basis of a neurosis is always a structural conflict as well; 
one of the conflicting instincts represents the ego, that is, is sustained by an ego 
defense, or strengthened for purposes of ego defense. Although itself an instinct, 
it acts as a defense against a more deeply repressed instinct. The concepts of 
‘‘instinct” and “defense” are relative; the two are always interpenetrated; reaction 
formations especially make use of reinforcements of instincts with opposite aims. 
Instincts contradictory in aim, without such reinforcement by the defending 
ego, would not conflict with each other. Within the realm of the id there is no 
conception of contradiction, logical order is here nonexistent. Instincts contra- 
dictory in aim can be satisfied one after the other, sometimes even simultaneously, 
by one and the same derivative. Freud raised the question as to why certain 
persons experience contradictory instincts as conflicting and are troubled about 
them, whereas others do not feel them as conflicting at all (629) . The answer is 
that this depends upon whether or not the contradiction between the instinctual 
aims involves a structural conflict as well (433, 438). 

In the last analysis, anxiety and guilt feelings motivating structural conflicts 
also express instinctual demands, namely, demands of a self-preserving instinct, 
or of an instinct to preserve mother’s love. 

To summarize: The fact that there arc conflicts between instincts does not 
necessitate any change in the formula: the neurotic conflict takes place between 
the id and the ego. 

THE EXTERNAL WORLD IN NEUROTIC CONFLICTS 

, The motives of defense arc rooted in external influences. However, the ex- 
,/tcrnal world as such cannot repress. It can only compel the ego to develop re- 
pressing forces. Without an intrapsychic institution that represents and anticipates 
the external world, no defense and no neurosis could arise. An original conflict 
between the id and the external world must first have been transformed into a 
conflict between the id and the ego before a neurotic conflict can develop. 
f The external world cannot ward off impulses except through the ego. How- 
ijCver, external perceptions perhaps may be warded off, and in this way participate 
^in a neurotic conflict. In the discussion of traumatic neuroses, fainting and the 
blocking of further perceptions demonstrated that the external world (the per- 
ceptions) may be warded off. A similar phenomenon occurs in psychoneuroscs: 
there are negative hallucinations, representing a warding off of some part of 



THE MOTIVES OF DEFENSE 


the external world; there is forgetting or the misinterpreting of outer events 
to achieve wish fulfillment; there are all kinds of mistakes in reality testing under 
the pressure of derivatives of unconscious wishes or fears. Whenever a stimulus 
gives rise to painful feelings, a tendency is developed not only to ward off these 
feelings but also to ward off the stimulus. 

However, none of these neurotic falsifications of reality can be distinguished 
exactly from repressions that are directed against one’s own impulses. The ex- 
ternal world is warded off as a possible source of punishment or as a possible 
source of temptation to unconscious objectionable drives. Situations are avoided 
or forgotten because they represent an inner instinctual demand. Here, again, 
the conflict between the ego and the external world reflects a conflict between 
the ego and the id. 

Sometimes a part of the external world is warded off not to avoid the mobiliza- 
tion of an instinct but to deny the idea that the instinctual act may be dangerous 
or cause pain; that is, the prohibitive character of the external world may be 
warded off. In general, this type of denial cannot be carried far in neuroses be- 
cause the reality-testing function of the ego prevents a too obvious falsification 

( 540 - _ _ ■ 

Freud once expressed the opinion that herein may lie the basic difference] 
between neurosis and psychosis. Both disturbances are based on a conflict be- 
tween an instinctual impulse and a fear of the possible pain connected with it: 
the neurotic individual represses the instinct and thus obeys the threatening ex- 
ternal world; the psychotic individual denies the external world and obeys his 
urgent instinct (611). This contrast, however, is only relatively valid (614). 
First of all, wish-fulfilling falsifications also occur in every neurosis, Freud 
studied them especially in fetishism (621); and he showed later that frequently 
persons who consciously know some fact very well indeed behave as if they had 
not noticed it or did not believe it. The ego of such persons is actually split into a 
conscious part that knows reality and an unconscious part that denies reality. 
Often such a split manifests itself in slips and errors (633, 635). Second, there is 
no doubt that psychotics who falsify reality do not always do so in terms of a 
simple wish fulfillment; very often they do so to escape an instinctual temptation, 
or to defend themselves against their instincts, exactly as neurotics do, only 
applying other mechanisms and deeper regressions (cf, 663) {see pp. 439 ff.). 

To summarize: There are defensive attitudes against painful perceptions just* 
as there are defenses against any pain. Nevertheless, in psychoncuroses based on: 
the blocking of discharge, the defenses against instinctual impulses remain inj 
the foreground; defenses against perceptions (and affects) seem to be performedf 
first and foremost in the service of defenses against instincts. Again: the neurotif 
conflict takes place between the ego and the id. 



132 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


THE SUPEREGO IN NEUROTIC CONFLICTS 

The superego, o£ course, brings some complication into the picture. The con- 
flict vs, id would in some neuroses more correctly be written ego -h superego 
vs, id, and in others ego vs. id superego. 

After the superego has been established, it is responsible to a great extent for 
the decision as to which discharges are permitted and which arc negated. The 
warding-off ego acts under the command of the superego, and wherever it is 
not simple anxiety but guilt feelings that motivate the defense, the formulation 
ego + superego vs, id is correct. 

On the other hand, in many neuroses (especially in compulsion neuroses and, 
to an extreme degree, in depressions) the ego defends itself against guilt feelings. 
All the defense mechanisms usually employed in the fight against instincts may 
also become directed against the “anti-instincts” originating in the superego. In 
such cases, the ego develops a double countercathexis, one against the instincts 
and another one against the superego. And the warded-off guilt feelings may in 
turn break through against these defenses in a distorted form, in the same way 
as instincts do : ego vs. id + superego (see pp. 290 fl. and 397 fl.). 

Again we may summarize: The superego may participate on either side in the 
neurotic conflict, but the formulation remains valid; the neurotic conflict takes 
place between the ego and the id. 

ANXIETY AS MOTIVE FOR DEFENSE 

Let us recapitulate what already has been stated about the motivations of 
neurotic conflicts (see pp. 51 £.), The infant, unable to attain satisfaction by his 
own efforts, necessarily often gets into traumatic situations, from which the first 
idea arises that instincts may be dangerous. Then more specific experiences show 
that instinctual acts may actually be dangerous; this impression may be war- 
ranted, or may be based on an animistic misinterpretation. The ego turns against 
instincts because it believes — correctly or incorrectly — ^them to be dangerous. 
Thus the problem of anxiety is the essence of any psychology of neurotic con- 
flicts (618). 

The primary anxiety, or the first experiences out of which later anxiety de- 
velops, is a manifestation of unmastered tension. It is an automatic occurrence 
that takes place whenever the organism is flooded with excitement; the symptoms 
of the traumatic neurosis show that it is not limited to infancy. This primary 
or traumatic anxiety occurs automatically, makes its appearance as panic, and 
is experienced by the ego passively; it can be understood partly as the way in 
which the unmastcred tension makes itself felt and partly as an expression of 
vegetative emergency discharges. 

Later on, the ego learns to use previously automatic archaic reactions for 
its purposes. The ego’s judgment of impending danger brings the organism into 



THE MOTIVES OF DEFENSE 


133 


a state similar to that of a trauma, but of lower intensity. The “tamed’’ anxiety, 
thus developed by the ego in the case of danger, may be called an anxiety signal, 
for it is used to indicate the necessity for starting defensive action (618). That 
component of anxiety appropriate to danger situations, preparation for defense, 
arises from the fact that it is the ego that uses anxiety; what is inappropriate, the 
fact that anxiety sometimes blocks the pertinent attitude, is due to the circum- 
stance that the ego has no other material at hand than an archaic automatic 
mechanism. 

Thus in the last analysis, all anxiety is a fear of experiencing a traumatic state, 
of the possibility that the organization of the ego may be overwhelmed by excita- 
tion. However, after the ego is developed enough to control instinctual actions . 
and to bring about gratifications, the instinctual impulses ought not to be fright- 
ening anymore. If they still arc, it is due to the fact that fears over loss of love or 
of castration have induced the ego to block the normal course of its excitements, 
thus creating an insufficiency of discharge (431). 

Sometimes, as has been stated, the ego’s capacity to tame anxiety fails. The. 
judgment that was intended to avert a traumatic state may actually induce it. 
This happens in the anxiety spells of anxiety hysterias, but it also happens in 
normal persons when they react to danger with paralyzing panic. The ego’s 
intention to give an anxiety signal fails when the person in whom the failure 
occurs is, as a result of previous repressions, in a dammed-up state; the slight 
anxiety added by the judgment of danger acts like a lighted match in a pow- 
der keg. 

Among a group of persons subjected to the same real danger, those arc more 
likely to react with panic who have no opportunity to master their tension in any 
other way. Such opportunity may be blocked by external circumstances; it is easier 
to master anxiety while some task is to be fulfilled or some motions can be made 
than if one is forced to wait quietly. Or the opportunity may be blocked by inter- 
nal circumstances, by a state of ‘‘readiness for anxiety,” due either to antecedent 
strain or to previous repressions. This also holds true for children, whose reaction, 
besides, is also dependent on that of the grownups around them (541). 

This triple stratification of anxiety may be summarized in a short table: 

ANXIETY 

(1) Trauma Anxiety automatic and unspecific 

(2) Danger Anxiety in the service of the ego, affect 

created by anticipation, controlled and 
used as a warning signal 

(3) Panic Ego control fails, affect becomes over- 

whelming, regression to state (i) ; anx- 
iety spell in anxiety hysteria 



134 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

The same triple stratification o£ anxiety will be found again in all other affects. 

Should the anxiety signal be designated as a countercathexis? This seems 
warranted because it is initiated by the ego and based on an active anticipation 
of some future possibility. On the other hand it is the expression of an auto- 
matic occurrence in the depth of the organism as a consequence of the ego’s 
reaction; it is not created by the ego; it is, rather, used by it. In this sense, the 
anxiety signal is a typical example of the dialectic nature of countercathexis in 
general. The forces the ego uses against the instincts are derivatives of the in- 
stincts themselves. 

GUILT FEELINGS AS MOTIVE FOR DEFENSE 

The neurotic conflict becomes more complicated when anxiety is replaced by 
guilt feelings. Guilt feelings represent a topically defined anxiety, the anxiety of 
the ego toward the superego. 

Guilt feeling proper— that is, the feeling “I have done wrong,” a painful judg- 
ment about some past occurrence which has the character of remorse — must be 
distinguished from feelings of conscience which do not judge the past but the 
future: “1 should do this,” or “I should not do that.” This part of conscience has 
a warning function and directs future actions of the personality. 

Having designated the ego’s judgment “Do not do that, otherwise something 
terrible may happen” as the root of “danger anxiety,” we now may assume that 
the warning conscience feeling is a special case of the same ego function: “Do 
not do this, otherwise some specific terrible thing may happen.” 

What is this specific thing? What does “punishment by the superego” or 
“loss of the superego’s love” actually mean? Obviously, that type of pain is 
feared which is actually felt, to a greater or less degree, in guilt feeling proper. 
The warning function of conscience expresses the ego’s tendency to avoid the 
pains of intense guilt feelings. These pains constitute a specific displeasure, the 
avoidance of which is the aim of the conscientious person. As long as a real pun- 
ishment is feared, or hell is thought of as a threatening reality, there is no true 
conscience yet, for the tendency to avoid punishment and hell does not differ 
from tendencies developed by other anxiety signals. In “conscience” the fear is 
internalized, and the danger threatens /row? within. Fear is felt not only lest some- 
thing terrible occur within the personality but also lest there be a loss of certain 
pleasurable feelings, such as well-being, protection, and security, which were 
hitherto present. This feared loss may be characterized as a loss of self-esteem, 
the most extreme degree of which is a feeling of annihilation, 
f To summarize, the warning conscience says : “Avoid this or that action, other- 
^,wise you will experience a feeling of annihilation.” Guilt feeling proper is more 



THE MOTIVES OF DEFENSE ^35 

or less a materialization of this threat, which in turn may be used to avoid future 
similar actions, which might even intensify the feeling of annihilation. 

This feeling of annihilation must be characterized as a cessation of the narcis- 
sistic supplies which were initially derived from the affection of some external ' 
person and later from the superego. 

The consideration that what the normal conscience tries to avoid has actually 
happened in melancholia makes the melancholic feeling of annihilation com- 
parable with the paralyzing panic in the third type of anxiety. The table of 
triple stratification given for anxiety may also be applied to the problems of 
guilt feeling. Conscience and warning guilt feelings correspond to the second- 
state (to the warning “danger anxiety”), the melancholic feeling of annihilation 
to the third state, panic. But what corresponds to the first state of “trauma”.? 

In anxiety, the first state was the unspecific painful experience which the infant 
had to undergo in a traumatic state. In the case of guilt feeling the situation must 
be similar, but more specific. The assumption that here the feeling of a “dan- 
ger from within” is not so much based on a general “traumatic tension” but on 
specific feelings of hunger can be supported by many clinical experiences about 
the connection between guilt feelings and oral strivings, to be discussed more * 
fully later {see p. 136). Thus a new triple stratification may be formulated for 
guilt feeling: 

GUILT FEELING 

(1) Trauma Feeling of hunger or annihilation auto- 

matic 

(2) Danger “Annihilation” in the service of the 

ego, affect created by anticipation, con- 
trolled and used as a warning signal 

(3) Panic Ego control fails, affect becomes over- 

whelming, regression to state (i); “an- 
nihilation” spell in melancholia 

Now an important complication must be added: the primary actual hunger is";- 
for milk. Later on, narcissistic supplies are missed in the same way in a kind of 
mental hunger. 

Total lack of narcissistic supplies makes even grown-up people apathetic and 
pseudo depressed — in extreme cases they may even try to satisfy their hunger by - 
a regression into a state of hallucinatory wish fulfillment. This apathy is the model 
of what subsequent guilt feelings tend to warn of. 

When the ego is sufficiently developed to form a judgment that there is danger) 
of a cessation of essential narcissistic supplies, the aim of its signal, “annihilation j 



136 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


may occur,” must be to influence objects to furnish these supplies. This state 
represents the anxiety over loss of love which plays so important a role as a motive 
for defense. 

In persons whose self-esteem is regulated by the anxiety over loss of love, sec- 
ondary anxieties and guilt feelings may be aroused if they try to enforce the neces- 
sary supplies by objectionable means. Particularly unfortunate are persons who 
need narcissistic supplies but who at the same time unconsciously arc afraid of 
receiving them. 

The anxiety over loss of love, or rather the anxiety arising out of loss of narcis- 
sistic supplies, turns into anxiety over loss of the superego s supplies, and the fear 
into guilt feeling. Thus the second stage of the table about guilt feeling must be 
divided into two substages: in the first, the loss of narcissistic supplies threatens 
from without, in the second from within. Now the parallelism between anxiety 
and guilt feelings may be completed with the table on page 137. 

The change from state (2a) in the table to (2b) is initiated when the anticipat- 
ing ego begins to guard against any action on its part that might result in a loss of 
the necessary parental love; the change is completed with the resolution of the 
Oedipus complex by the introjection of its objects. The state (ib) is an essential 
characteristic of mental normality. Everyone continually experiences slight “con- 
science signals” which regulate behavior and which arc of far greater importance 
as constituents of the so-called mood than general anxiety signals are. 

"Conscience” becomes pathological when it (a) functions in too rigid or too 
automatic a manner, so that realistic judgment about the actual outcome of in- 
tended actions is disturbed (“archaic superego”) or (b) when the breakdown 
toward “panic” occurs and a greater or lesser sense of complete annihilation is 
experienced instead of a warning signal, which is the case in severe depressions. 
The causes of such failure of conscience will be investigated later {see pp. 388 f.). 
Here a few remarks are pertinent on certain features that are characteristic of 
guilt feelings in general. 

Guilt feelings are connected intimately with oral sensations, or rather with 
intestinal sensations. The monograph by Nunberg about guilt feelings (1175, 
1179; *i’ 849 > supplies abundant evidence on this thesis. For example, 

remorse and compulsion symptoms with the significance of atonement as well 
as all attempts to "undo” something in order to satisfy conscience are regularly 
unconsciously thought of as a giving back of contents of the body (959). And 
this is the case not only if the deed itself has been regarded as an incorporation. 
It arises, also, from the circumstance that the superego is felt as an introject 
pressing from within. 

f The refusal of food by depressed persons generally expresses the idea that this 
( pressure from internalixed objects should not be increased by incorporating still 
(other objects (see pp. 389 and 394). 



GUILT FEELING 

ANXIETY (A SPECIFIC ANXIETY) 


THE MOTIVES OF DEFENSE 


^37 


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. whelming, regression to state (i) ; anx- whelming, regression to state (i) ; “an- 

iety spell in anxiety hysteria nihilation” spell in melancholia 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


^38 

Guilt feeling not only has an oral character in general but an oral-sadistic char- 
acter in particular, The term qualms of conscience expresses this as well as the 
German Gewissensbisse, both expressions being mere descriptions of the way 
in which the sensations are actually felt. 

However, guilt feelings are not manifested in bowel sensations alone. The 
genetic relation to anxiety is shown in the fact that a bad conscience may produce 
the same circulatory and respiratory sensations as anxiety. “My heart is heavy,” 
or “I am not able to breathe freely” are expressions of bad conscience. 

In the case of depression, a decisive pathogenic regression increases this sadistic 
nature of the superego. 

The idea has been expressed that anxiety may correspond to the repression of 
sexuality, whereas guilt feeling may correspond to the repression of aggressive 
drives (97, 624). This seems too gross a co-ordination. 

The ego, wedged between instinctual demands and guilt feelings, has two 
possibilities: it may obey the superego and turn against the drives, or it may 
rebel against the superego. There are as many compromises possible between 
obedience to and rebellion against the superego as there are compromises be- 
tween obedience to and rebellion against external authorities. A very frequent 
type of compromise is temporary ingratiation for the purpose of preparing a 
later rebellion. 

A few words arc relevant about the conception pf a need for punishment. The 
pressure from the part of the superego to which the ego is exposed creates first 
of all a need for getting rid of this pressure, for regaining the lost self-esteem, 
and for reassurance against possible feelings of annihilation. This aim is best 
achieved by “forgiveness.” After the experience that punishment may be a means 
of achieving forgiveness, a need for punishment actually may develop. The 
punishment longed for is a means of achieving forgiveness; the individuals in 
question certainly would prefer it if they could achieve forgiveness without first 
undergoing punishment. In “moral masochists,” however, the situation may be 
more complicated: punishment may be asked for not as a means for forgiveness 
only but also as .a kind of distorted substitute for sexual gratification {see pp. 364 
and 501 f.). 


DISGUST AND SHAME AS MOTIVES FOR DEFENSE 

Less is known about other affective motives of defense, but it seems that their 
origin and development can likewise be clarified by applying the tabic of triple 
stratification. 

( Disgust as a motive of defense certainly is directed against oral demands, a fact 
• that connects it with guilt feelings. Actually, certain feelings of disgust are very 



THE MOTIVES OE DEFENSE 139 

similar to certain types of guilt feelings, for example, disgust with oneself. The 
connection with anal eroticism is, of course, also obvious. 

Applying the triple stratification table to disgust, we may say: 

1. The forerunner of disgust is an archaic physiological defense syndrome 
which is automatically produced as soon as something repulsive reaches the 
digestive tract. The first negative judgment of the infant s pre-ego is “This is 
not edible,’* which means “I should spit this out.” 

2. The strengthened ego learns to use this reflex for its purposes and turns 
it into a defense — first into an expression of negation in general (6i6), later into 
a defense against certain sexual, especially oral and anal, drives. This, again, 
is a signal : “If you do not give up this demand, you will have to spit and vomit.” 

In a normal child a part of his anal-erotic interest in feces may be turned di- 
reedy into a readiness to develop reactions of disgust (555). Overly intense dis- 
gust reactions betray their character as a reaction formation by an occasional 
breaking through of the original coprophilia in dreams or in symptomatic acts. 
The disgust of hysterics as a response to sexual temptation may be looked upon 
as an extreme denial of unconscious receptive sexual strivings: ‘T not only do not 
want to take anything into my body; I even want to spit or vomit something out 
of my body.” 

3. There are neurotic “attacks of disgust,** corresponding to “panic” in anxiety, 
in which the ego, because of previous blockings, is completely overwhelmed 
by the affect which was intended for defense purposes (440) . 

Shame as a motive for defense is mainly directed against exhibitionism and 
scoptophilia. It is not simply a specialized form of castration anxiety (fear of the 
castrating “evil eye”) (430, 1420), but a more specific feeling, in the last analysis 
undoubtedly also rooted in a primitive physiological reflex pattern (470, 555, 
636, 1177). Shame, too, in many respects is connected with guilt feelings — 
“shame of oneself” (588). 

“I feel ashamed” means “I do not want to be seen.” Therefore, persons who 
feel ashamed hide themselves or at least avert their faces. However, they also 
close their eyes and refuse to look. This is a kind of magical gesture, arising from 
the magical belief that anyone who does not look cannot be looked at. 

It is an interesting fact but one not easy to explain that shame seems to be con- 
nected in a specific manner with the phenomena of urethral eroticism. That the 
specific shame punishment of pillorizing is customarily used against wetting 
only shows that the same connection between shame and urethral eroticism was 
already effective in the previous generation. The aim of ambition based on ure- 
thral eroticism is to prove that there is no need to be ashamed anymore. 

Probably the following phases may again be differentiated: (i) Shame as an 
archaic physiological reaction pattern. Being looked at is automatically equated ^ 
with being despised. (2) The ego uses this physiological pattern for defense pur- 
poses; signal: “If you do this or that, you may be looked at and despised/* 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 

(3) The signal fails to operate in dammfed-up persons, so that an overwhelming 
paniclike shame is experienced. 

As in guilt feelings, the ego may turn not only against instinctual impulses 
in obedience to disgust and shame but may also ward off the affects of disgust 
and shame themselves (440, i486). 

SUMMARY 

In the neurotic conflict (between the ego and the id) an instinctual drive 
seeks discharge in a struggle against an opposing anxiety (guilt feeling, disgust, 
shame). The drive tends toward the world; the counterforces tend toward with- 
drawal from the world. The drive seems to be governed by its hunger for objects; 
the counterforces seem to be governed by a striving to avoid objects. 

ARE THERE ANY INNATE PRIMARY ANTI-INSTINCT FORCES? 

Do any innate tendencies exist to suppress or inhibit sexual or aggressive im- 
pulses, besides externally aroused feelings of anxiety, guilt, shame, and disgust, 
tendencies that might operate even without frustrating experiences ? Perhaps the 
helplessness of the human infant, which necessarily brings about traumatic 
states, suffices to create a primary hostility of the ego to the instincts? Perhaps a 
taboo on incestuous love, which is so drastically expressed in many primitive 
societies, may be something innate, and a main cause for the forces effective 
against the Oedipus complex.? 

Ideas of this kind do not seem to be warranted. There is no evidence that 
hypotheses of this type are necessary for the purpose of explaining the facts of 
the neuroses. The effects of infantile helplessness would ordinarily be over- 
come when the child is no longer helpless; if they persist, it is due to experiences 
that convinced the child of the dangerous nature of his impulses. Whenever we 
analyze neurotics, whose incest taboo has made them repress their Oedipus 
complex, we find that experiences are responsible for the anxieties and guilt 
feelings, and that they are the motivating forces for their repression. 



Chapter IX 

THE MECHANISMS OF DEFENSE 

CLASSIFICATION OF DEFENSES 

Ego defenses may be divided into (a) successful defenses which bring about a 
cessation of that which is warded off, and (b) unsuccessful defenses which 
necessitate a repetition or perpetuation of the warding-of? process to prevent the 
eruption of the warded-off impulses. 

Pathogenic defenses, which are at the basis of neuroses, belong to the second 
category: when opposed impulses cannot find discharge, but remain in suspen- 
sion in the unconscious and are still heightened by the continued functioning of 
their physical sources, a state of tension results and a break-through may occur. 

Hence the successful defenses are of less importance in the psychology of 
neuroses; they are actually less understood (r/. 1032). However, the borderlines 
between the two categories are not always sharply defined, and sometimes it 
is not possible to distinguish between ‘‘a drive changed by the influence of the 
ego” and “a drive that breaks through in a distorted way against the will of the., 
ego and unrecognized by it.” The latter type of impulse will produce cramped 
attitudes, will repeat itself again and again, will never permit full relaxation, 
and will cause fatigue. 


SUBLIMATION 

The successful defenses may be placed under the heading sublimation. This 
term does not designate a specific mechanism; various mechanisms may be used 
in successful defenses, such as a change from passivity to activity, a turning 
round upon the subject, a reversal of aim into its opposite (588). The common 
factor is that under the influence of the ego, aim or object (or both) is changed 
without blocking an adequate discharge. (The factor of valuation usually in- 
cluded in the definition of sublimation had better be omitted [127, 137].) Sub- 
limation is to be differentiated from defenses that use countercathexes; sub- 
limated impulses find their outlet, though drained via an artificial route; 
whereas the others do not. In sublimation, the original impulse vanishes because 
its energy is withdrawn in favor of the cathexis of its substitute. In the other 
defenses the libido of the original impulse is held in check by a high counter- 
cathexis (555, 1499). 

Sublimations require an unchecked stream of libido just as a mill wheel needs’ 
an unimpeded and channeled flow of water (773)* For this reason, sublimations' 
appear after a repression has been removed (596, 599). Metaphorically, the de- 
fensive forces of the ego do not oppose the original impulses head on, as in the. 



142 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


case of a countercathexis, but impinge at an angle, producing a resultant, which 
unifies instinctual energy and defensive energy and is free to proceed. Sublima- 
tions are distinguished from neurotic substitute gratifications by their desex- 
ualization; that is, the gratification of the ego is no longer an obviously instinctual 
one. 

What drives may experience such a vicissitude and what circumstances deter- 
mine whether or not sublimation is possible? 

If the pregenital impulses and the concomitant aggressive attitudes are not 
warded off by the development of a countercathexis (which would exclude them 
from the subsequent development of the personality), they are organized later 
under the genital primacy. The more or less complete achievement of this 
organization is the prerequisite for a successful sublimation of that part of 
pregenitality which is not used sexually in the forepleasure mechanisms. It is 
highly improbable that a sublimation of adult genital sexuality exists; the genitals 
represent an apparatus for the achievement of full — that is, unsublimated — 

^ orgastic discharge. Pregenital strivings are the object of sublimation. If, however, 
' the pregenital strivings have been repressed, and remain in the unconscious, 
. competing with genital primacy, they cannot be sublimated. The capacity for 
genital orgasm makes the sublimation (desexualization) of pregenital strivings 
possible (308). 

What determines whether or not the ego will succeed in arriving at such a 
fortunate solution is not easy to say. Sublimation is characterized by (a) an in- 
hibition of aim, (b) a desexualization, (c*) a complete absorption of an instinct 
into its sequela, and (d) by an alteration within the ego. All these qualities can. 
also be seen in the results of certain identifications, as, for example, in the 
process of formation of the superego. The empirical fact that sublimations, 
especially those that arise in childhood, depend upon the presence of models, 
upon incentives directly or indirectly supplied by the environment, corroborates 
i Freud’s assumption that sublimation may be intimately related to identification 
(608). Moreover, the cases of disturbances in the capacity to sublimate show 
' that such an incapacity corresponds to difficulties in making identifications (173). 
Just as with certain identifications, sublimations, too, may more or less success- 
fully combat and undo infantile destructive impulses (1422, 1424), but also and 
in a distorted fashion give way to these same destructive impulses; in a certain 
sense, every artistic fixation of a natural process is a ^‘killing” of this process 
(1332). Forerunners of sublimations can be seen in certain children’s games, 
in which sexual strivings are satisfied in a ‘‘desexualized” way after some dis- 
tortion of aim or object; and identifications are also decisive in this type of 
game (541, 956), 

The extent of the diversion of aim in sublimation varies greatly. In some cases 
the diversion is limited to an inhibition in aim; the person who has made the 



THE MECHANISMS OF DEFENSE 


143 


sublimation does exactly what his instinct urges him to do, but does so after the 
instinct has been desexualized and subordinated under the organization of the 
ego. In other types of sublimation, changes occur that are much more far 
reaching. It is even possible that an activity opposite in direction to the original 
instinct may really have replaced the original instinct. Certain disgust reactions 
—usual among civilized people— that show no trace of the infantile instinctual 
tendencies against which they were originally developed belong in this category 
(555) • is identical with what Freud has described as transformation into 

the opposite; after its completion the entire force of an instinct operates in the 
opposite direction (588), 

PATHOGENIC DEFENSES 

Conflicts between instinctual demands and fear or guilt feeling are not neces- 
sarily pathological. The way in which the conflicts are handled determines 
whether the further course is a normal or pathological one. As long as normal 
instinctual demands have their place within the total personality and can achieve 
periodic satisfaction, the remaining conflicts have a relatively minor intensity and 
can be solved without pathological results. The ability to discharge instinctual ten- 
sions by periodic gratification is the best guarantee for mental health and also a 
prerequisite for undisturbed sublimation. The parts of instincts which during 
childhood have clashed with defenses of the countercathexis type, however, 
are excluded from this possibility of periodic discharge. The countercathexes do . 
not change the warded-ofiE instincts into anything else; rather they suppress 
them, They simply attempt to block their discharge, thereby causing them to 
lose connection with the remainder of the personality and to remain unchanged 
in the unconscious. Herein lies the danger of the break-through, which is the 
basis of neuroses. 

This development explains two facts of decisive importance: (i) The warded- 
off instincts exert a constant pressure in the direction toward motility. Deprived 
of their possibility for direct discharge, they use any opportunity for indirect 
discharge, displacing their energy to any other impulse that is associatively con- 
nected with them, increasing the intensity of this substitute impulse or even 
changing the quality of the affect connected with it. Such a substitute impulse is 
called a derivative (589, 590) . Most neurotic symptoms are such derivatives. (2) 

All pathogenic defenses have their roots in childhood ; and there is no psycho- 
neurosis that is not rooted in childhood. 

The isolating efFect of childhood defenses explains why a patient whose in- 
fantile sexual impulses are freed from repressions by psychoanalysis does notj 
simply strive to satisfy these infantile strivings that have now become conscious, y } 
After the infantile defenses have been canceled, the isolation is undone and the | 
warded-off strivings are connected again with the total personality, They now/ 



144 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


participate in the maturity of the personality; infantile drives turn into adult ones, 
which can be discharged. Thereafter, remainders can be handled by sublimation 
or by other more effective types of suppression. 

In discussing the traumatic neuroses, it was noted that the state of being 
flooded with excitation gave rise to the need for blocking acceptance of further 
stimulation; perception and other ego functions were blocked or diminished 
by forceful countercathexes. These types of “defenses,” especially their climax- 
fainting — may be regarded as the pattern according to which all other pathogenic 
defenses are formed: fainting is a complete cessation of the functions of the ego; 
other defense mechanisms consist of a partial cessation of certain functions of 
the ego (410). 

In the last analysis fainting as a defense mechanism and as the blocking of 
endangered functions is an outgrowth of a deep-seated biological reflex which 
causes not only endangered functions but also endangered organs to be aban- 
doned (autotomy). This reflex, with its aim to get rid of a tense organ for the 
sake of homeostasis, can be looked upon as the common root of both gratification 
of instincts and defense against instincts. 

DENIAL 

The tendency to deny painful sensations and facts is as old as the feeling of 
pain itself. In little children a wish-fulfilling denial of unpleasant realities is a 
very common thing, a simple expression of the effectiveness of the pleasure 
principle. 

The ability to deny unpleasant parts of reality is the counterpart of the “hallu- 
cinatory wish fulfillment.” Anna Freud has called this type of refusal to acknowl- 
edge displeasure in general “pre-stages of defense” (541). The gradual develop- 
ment of reality testing makes such wholesale falsification of reality impossible 
(575). However, these tendencies toward denial try to remain operative. They 
succeed best against certain single internal perceptions of a painful nature. Freud 
explained that the “negation” of such a perception may be a compromise between 
becoming conscious of the data given by the perception and the tendency to 
deny. The statement “I am glad that I have not had a headache for such a long 
j| time,” made prior to the onset of a headache, means “I feel the headache coming, 
’I but for the time being I can still deny it” “I do not know whom this person in my 
dream represents, certainly not my mother,” means “I feel that this person repre- 
sents my mother, but I am still able to deny it” (616). 

All attempts at denialin later phases of development have, of course, the ego’s 
functions of perception and memory as their adversaries. Painful experiences 
and the memories of painful experiences, automatically reproduced whenever 
anything resembles the origbal painful experience, force the organism to aban- 
don the methods of hallucinatory wish fulfillment and simple denial (507). The 
gradual development of the ego and of the reality principle strengthens experi- 



THE MECHANISMS OF DEFENSE 


145 

cnce and memory and slowly weakens the tendency to deny. As long as the ego 
is weak, the tendency toward denial may remain relatively superior; in later 
childhood, the characteristic solution is that the objectionable truth is denied 
effectively in play and fantasy, whereas simultaneously the reasonable part of 
the ego recognizes the truth and the playful or fantastic character of the denial 
(17^5 54 ^)- Some of this “denial in fantasy” remains in the normal adult who, 
knowing an unpleasant truth, nevertheless (or, rather, therefore) may enjoy 
daydreams that deny this truth. However, in adults, daydreams of this kind 
have an “unimportant” character and merely represent a refuge that brings a 
short relief from the burdens of reality, whereas games and denials in childhood 
are of major importance. Only in the case of severe disturbances of the function 
of reality testing (psychoses) do serious and important denials remain victorious 
in adults. To a minor degree, a split of the ego into a superficial part that knows 
the truth and a deeper part that denies it may, as an outcome of “denial in fan- 
tasy,” be observed in every neurotic. Though knowing the truth, he may act as if 
it did not exist (614, 633, 635). Freud described this first in the fetishist, who con- 
sciously knows the anatomy of the female genitals but who, in his neurotic symp- 
toms, acts as if women had penises (621) . 

Sometimes the struggle between denial and memory can be directly observed. 
An unpleasant fact may alternately be acknowledged and denied. If in this 
situation a kind of substitute object can be offered to perception or memory- 
one which though related to the objectionable fact is harmless — the substitute will 
be accepted and the struggle will be decided in favor of repression. The repressing 
ego, while involved in such a struggle with perception and memory, is seeking 
a substitute idea or a substitute experience. It develops a “hunger for screen ex- 
periences” (409, 413, 686, 1437) . 

This explains the existence of retroactive “screen memories” (553). The ego 
searches its store of memories for images which it may offer to its consciousness 
as a substitute. But also actual perceptions that occur during the struggle are 
immediately scrutinized by the ego as to their suitability for forming substitute 
images. The ego has a “free quantivalcnce” for screen experiences, and is eco- 
nomically relieved upon finding them. This relief is often experienced by chil- 
dren in a characteristic way, which may be called the command to remember 
(413). During an experience which is more or less harmless, but which may form 
the basis of a later screen memory, the child senses a kind of inner command: 
“Attention: This scene you are to remember throughout life!” Sometimes this is 
felt not as a strict command but as a wish to test one’s memory. 

There is a significant connection between command to remember and dSjd puj^ 
The unconscious situation in both phenomena is very similar in that an actual' 
experience is associated with a repressed one and serves as a substitute for it 
(582). Although the ideas “I have experienced this once before” and “I am going 



146 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


to remember this throughout life” differ greatly, the feelings that accompany 
the two types of experience arc very similar; occasionally a dejd vu experience is 
actually connected with a command to remember. However, in de]h vu the re- 
pression has already been completed, the ego does not want to be reminded of 
something that has been repressed, and the feeling of dejd. vu consists of its being 
reminded of it against its will. In the command to remember, repression is still 
in conflict with memory. The ego actively approves of the actual experience 
because with its help it can complete the repression. 

At times some actual occurrence is experienced with a feeling similar to dejh 
vu: *‘So it is really true that ...” This may mean either that the actual occurrence 
is reminiscent of something that was repressed, and this repression is now endan- 
gered by the occurrence (the repressed often being a guilt feeling), which is ex- 
perienced as uncanny. Or it may mean that what is “really true after all” is a 
reality free from frightening unconscious conceptions that were anticipated in 
connection with it; that is: “I no longer need to be afraid of things I had mis- 
takenly connected with reality.” In that case the feeling similar to di^a vu is 
relieving and pleasurable (442, 631). 

Sometimes certain types of behavior toward other persons can be explained as 
attempts to facilitate denials of unpleasant facts. For example, the obvious aim of 
lying is to make the other person believe something that is untrue or to disbelieve 
something that is true; the aim of habitual lying, however, may unconsciously 
be to produce the same effect in the liar himself. The attempt to convince someone 
of the reality of something that is unreal is made as a proof of the possibility that 
some data of memory may also be erroneous. The person who is deceived serves 
as a witness in the argument between one’s memory and the tendency toward 
denial (437) pp. 528£.). 


PROJECTION 

The first judgment of the ego distinguishes between edible and nonedible 
objects: the first acceptance is swallowing, the first rejection is spitting out (616). 
Projection is a derivative of the first negation; it has the content of “I want to spit 
it out” or, at least, of “I want to put distance between it and myself.” Projection 
is essential in that early stage of development of the ego which Freud has 
called the purified pleasure ego (588) in which everything pleasurable is ex- 
perienced as belonging to the ego (“something to be swallowed”), while every- 
thing painful is experienced as being nonego (“something to be spit out”). 

So long as the line of demarcation between ego and nonego is not yet sharp, 
which is true in the early years of childhood and again in psychoses, the mecha- 
nisms of the state of the purified pleasure ego may be used by the ego for de- 
fensive purposes. Emotions or excitations which the ego tries to ward off are 
“spit out” and then felt as being outside the ego. The offensive impulse is per- 
ceived in another person instead of in one’s own ego. Thus in the defense mecha- 
nism of projection the same holds true as in anxiety and guilt feeling: archaic 



THE MECHANISMS OF DEFENSE 


147 


reactions which in the early phases of development occur automatically later are 
tamed by the ego and used for its defensive purposes. However, this primitive 
mechanism of defense can be used extensively only if the ego’s function of real- 
ity testing is severely damaged by a narcissistic regression, thus blurring the 
boundaries between ego and nonego once more. The fact that projection is of 
utmost importance in archaic animistic cosmologies fits in with its essentially 
archaic nature (401, 8io, 854, 886, 937, 967, 1484). 

When the development of the libido leads to an overcathexis of the excretory 
functions, these functions, too, may be used as physical models for projection. To 
get rid of an objectionable object or impulse by removing it from the body in 
the way feces are eliminated is a very frequent fantasy (26). In paranoia, the 
disease in which projection reaches greatest height, this fantasy achieves its cli- 
max in persecutory delusions in which the persecutor outside the patient repre- 
sents the sensations he feels in his bowels ( 1203, 1465) {see pp. 428 f .) . 

In general, the organism prefers to feel dangers as threats from without rather 
than from within because certain mechanisms of protection against overly in- 
tense stimuli can be set in motion against external stimuli only. Many projec- 
tions give the impression that internal stimuli are misapprehended as external 
ones, with the intent of applying this protection to inner stimuli also (605). 

Whether every projection of certain tendencies or feeling attitudes necessarily 
always represents an expulsion of previously internalized objects — that is, in the 
last analysis, either a spitting out or a defecation — can hardly be decided clinically. 

Usually, projections in general are not performed at random but are directed 
toward some point in reality where they arc met halfway. The paranoid person 
is sensitized, as it were, to perceive the unconscious of others, wherever this per- 
ception can be utilized to rationalize his own tendency toward projection. He 
senses keenly the unconscious of others when this enables him to become oblivi- 
ous of his own unconscious (607) . Just as the “monsters” in the manifest content 
of a dream represent a “water animalcule” from daily life (1328), so the mon- 
ster of paranoid delusion may be a distortion of a microbe of reality. 

Animism is the most important general example of projection in normal ego 
development. Paranoid patients, whose function of reality testing is severely dis- 
torted, produce the most extreme projective misinterpretation of reality. Neu- 
rotic patients do the same thing to a lesser degree by misunderstanding the actual 
reality in the sense of their unconscious needs. 

DTIROJECTION 

Originally, the idea of swallowing an object is an expression of affirmation ^ 
(616). As such, it is the prototype of instinctual satisfaction, not of defense 
against instincts. At the stage of the purified pleasure ego, everything pleasant 



M8 the psychoan-alytic theory of neurosis 

is introjected. In the last analysis all sexual aims are derivatives o£ incorpora- 
tion aims. Simultaneously, introjection is the prototype of regaining the omnipo- 
tence previously projected onto adults. Incorporation, however, although an ex- 
pression of “love,” objectively destroys the objects as such— as independent things 
in the external world. Upon becoming aware of this fact, the ego learns to use 
introjection for hostile purposes as an executive of destructive impulses and also 
as a model for a definite defense mechanism (449, 454, 662, 886, 967, 1484). 

Incorporation is the most archaic aim directed at an object. Identification, per- 
formed by means of introjection, is the most primitive type of relationship to 
objects. Therefore any later type of object relationship, upon meeting with difh- 
culties, may regress to identification, and any later instinctual aim may regress 
to introjection. The use of introjection as a defense mechanism, again, provides 
an example of how primitive automatic mechanisms later are tamed and used 
by the ego for its purposes. 


REPRESSION 

Relatively less archaic is the mechanism of repression proper, certainly a de- 
rivative of the “denial” discussed above. It consists of an unconsciously purpose- 
ful forgetting or not becoming aware of internal impulses or external events 
which, as a rule, represent possible temptations or punishfnents for, or mere 
[allusions to, objectionable instinctual demands. The purposeful exclusion of these 
/ data from consciousness is obviously intended to hinder their real effects as well 
as the pain on becoming aware of them. However, although the repressed is not 
felt consciously it remains effective. The ego can get rid of it entirely only in those 
instances which have been designated as sublimation and which sometimes are 
called successful repression. In repression proper, based on continual counter- 
cathexis, the repressed remains effective from the unconscious (159, 589, 999). 

The pattern of repression is exemplified best in the case of the simple forget- 
ting of a name or an intention. Analysis reveals that a name or an intention is 
forgotten if a suppressed motive resisted it, usually because it was associated with 
some objectionable instinctual demand. In the case of tendential forgetting, the 
fact that the repressed still persists in the unconscious is sensed directly in the 
subjective feeling that one ought to know what has been forgotten, or even that 
one does know it “somehow,” “it is on the tip of the tongue,” although actually 
one docs not know it (553). 

If Sometimes certain facts are remembered as such, but their connections, their 
f significance, their emotional value are repressed. 

Conflicts arise when new experiences occur that are connected with what had 
previously been repressed. Then there is a tendency on the part of the repressed 
to use the new event as an opportunity for an outlet; it tends to displace its ener- 
gies to it, to turn the new event into a “derivative,” The tendency to use such a 



THE MECHANISMS OE DEFENSE 


149 


displar- merit as a means of gaining discharge sometimes succeeds. If neurotic 
exaggerations — namely, attitudes in which a relatively harmless thing is emotion- 
ally overevaluated — are analyzed, the results demonstrate that they are deriva- 
tives of something that had been repressed; the seemingly absurd emotional 
value becomes understandable as a product of displacement. At other times the 
attempt of the repressed to find an outlet in the form of derivatives fails: a tend- 
ency then develops to repress any event associatively connected with the origi- 
nally repressed material, in short, a tendency to repress the derivatives just as 
previously the original demand was repressed. This is called secondary repres- 
sion (Nackdracngen) (589). The impression arises that the repressed is like a 
magnetic force attracting everything that has any connection with it, so that it, 
too, becomes repressed ; actually, it does not attract associatively connected ma- 
terial into the repressed, but tries to transform it into a derivative, whereupon the 
same forces that had originally repressed it repress the new material as well. 

Sometimes derivatives of the repressed are alternately admitted to discharge 
and themselves repressed. Certain formations of this kind, such as daydreams, 
may be enjoyed in a highly emotional way up to a certain degree; but they are 
entirely and instantly forgotten when this degree is transgressed (590). The same 
holds true for dreams, where there is likewise but one step from highly emotional 
dreams, which obtrude obsessively upon consciousness, to dreams that are en- 
tirely forgotten. 

Thus repressions may either betray themselves by voids — that is, by the fact 
that certain ideas, feelings, attitudes that would be expected as adequate reac- 
tions to reality arc actually missing — or they may betray themselves by the obses- 
sive character with which certain compensating ideas, feelings, and attitudes 
that represent derivatives are clung to (1532). The first is to be seen in secondary 
repression; the second in screen memories (553) and in obsessional ideas. 

There are many connections between repression and projection as well as be- 
tween repression and introjection. Sometimes repressed ideas are unconsciously 
felt as objects that have been removed from the ego; this brings repression near 
to projection. At other times repressed ideas are felt as if they had been swal- 
lowed, a similarity to introjection based on the fact that what has been swal- 
lowed has ceased to be visible but is nevertheless still effective from within 
(1436), Dreams occurring in the course of an analysis often show that the re- 
pressed material is unconsciously looked upon as swallowed food, or even as 
feces or vomitus. 

Repression proper is the main mechanism of hysteria. It expresses an attitude 
in which the objectionable thing is treated simply as if it were nonexistent. Per- 
haps the fact that sexual impulses very often arc repressed, whereas aggressive 
impulses are more often the subject of other defense mechanisms, is due to the 
circumstance that education frequendy handles the subject of sex by simply not 



150 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


mentioning it, whereas the existence of aggressiveness is acknowledged but is 
designated as bad. The more consistently educators apply prohibitions by acting 
as if the objectionable things did not exist, the more repression proper is encour- 
aged in children. The inconsistency of present-day education, uncertain as to 
which instinctual claims to permit and which to suppress, resulting in initial per- 
mission and in subsequent sudden, unexpected (and therefore frequently more 
cruel) deprivation, favors the use of defense mechanisms other than repression. 

The motive of repression is unquestionably the tendency to withhold that 
which has been repressed from motility (552) . Proof of this is the fact that re- 
pression becomes superfluous when the inactivation is guaranteed in some other 
way. Compulsion neurotics are able to think obsessively about murder because 
through the application of the mechanism of isolation they are sure that they 
will not actually commit the crime (see pp. 289 f .) . 

Orgel described a manifest Oedipus dream that occurred after the patient had 
had some experience that made him actually hate his mother. Under other cir- 
cumstances he certainly would have repressed his incestuous wishes. The hatred 
which assured him that he would not actually make love to his mother permitted 
the temporary lifting of the repression (1208; cf, also 1033). 

Since the repressed continues to exist in the unconscious and develops deriva- 
tives, repression is never performed once and for all but requires a constant ex- 
penditure of energy to maintain the repression, while the repressed constantly 
tries to find an outlet (589). This expenditure may be observed in clinical phe- 
nomena : for example, in the general impoverishment of the neurotic person who 
consumes his energy in the performance of his repressions and who therefore 
does not have enough energy at his disposal for other purposes. This explains 
certain types of neurotic fatigue. Some of the typical neurotic feelings of in- 
feriority correspond to awareness of this impoverishment (585); attitudes are 
developed to avoid situations in which a new mobilization of the repressed may 
occur (phobias) ; and attitudes even appear which, to ensure that the repressed 
remains repressed, are contrary to those of the original impulses. 

In describing repression, Freud first differentiated between the destiny of the 
repressed idea and the destiny of the quantity of emotional cathexis of the re- 
pressed idea (589). The idea, that is, the ideational content, is forgotten; the emo- 
tional cathexis, however, may make its appearance through displacement to an- 
other idea, It is certainly true that sometimes the displacement of the cathexis to 
a less objectionable derivative, which finds discharge or access to consciousness, 
facilitates the repression of the original idea, as in screen memories (354, 1532), 
However, it is not possible to separate the conceptions of “idea” and “cathexis of 
the idca^^ entirely. If the tehole cathexis were displaced, the original idea would no 
longer exert any pressure toward motility, the defensive struggle would become 
superfluous, and the whole process would then be called sublimation rather than 
repression. Actually the typical “derivatives” contain only a part of the repressed 



THE MECHANISMS OF DEFENSE 


cathexis. Not mere “ideas” are repressed but “impulses,” that is, cathected ideas of 
future actions, wishes for actions (of course not only primary id wishes but also 
their later elaborations and ego attitudes). The displacement of the emotional 
cathexis to a derivative already represents a kind of failure on the part of the re- 
pressing forces, which could not attain their aim of suppressing every expansion 
of the repressed impulse. However, this failure may facilitate the task of keeping 
the original idea unconscious. 

REACTION PORMATION 

There arc many neurotic attitudes that are obvious attempts to deny or to re- 
press some impulses, or to defend the person against some instinctual danger. 
They are cramped and rigid attitudes, hindering the expression of contrary im- 
pulses, which sometimes nevertheless break through in various ways. In such 
traits, psychoanalysis as an “unmasking” psychology can prove that the original 
opposite attitude still exists in the unconscious. These secondary opposite atti- 
tudes are called reaction formations (555). 

Do reaction formations represent a separate and independent mechanism of 
defense ? They seem rather to be a consequence and reassurance of an established 
repression. But at least they signify a certain type of repression, which can be 
distinguished from other repressions. It is a type of repression in which the coun- 
tercathexis is manifest and which therefore succeeds in avoiding oft-repeated 
acts of secondary repression. The reaction formations avoid secondary repressions 
by making a “once-and-for-all,” definitive change of the personality. The person 
who has built up reaction formations does not develop certain defense mecha- 
nisms for use when an instinctual danger threatens ; he has changed his person- 
ality structure as if this danger were continually present, so that he may be ready 
whenever the danger occurs. Examples are the cleanliness or the sense of order 
of the compulsion neurotic who struggles, by means of those character traits, 
against his instinctual demands for dirt and disorder. The rigidity of such clean- 
liness or sense of order as well as the occasional breakings through of dirtiness 
and disorder betray the reactive quality of these character traits. 

A break-through may occur in dreams as well as in the waking state. An occa- 
sional instinctual action may become possible again and the reaction formation 
may become insufficient under certain economic or qualitative conditions. Most 
pathological character traits correspond to the reaction formation type; that is, 
whereas normal character traits permit discharge, the majority of pathological 
traits primarily serve the purpose of keeping still existent opposite tendencies in 
the unconscious (sde pp. 471 ffi). 

Certain mechanisms of defense represent intermediate forms between simple 
repression and reaction formation. A hysterical mother who unconsciously hates / 
her child may develop an apparently extreme affection for the child, for the pur- ^ 
pose of making the repression of her hatred secure. Descriptively, this may be ’ 
called a reaction formation. But it docs not imply a change of the total personal- ' 



152 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


ity ill the direction o£ kindness or consideration in general. The kindness remains 
limited to the one object, and even there it has to be re-established whenever the 
occasion, demands. In contradistinction, a compulsion neurotic who develops a 
true reaction formation against hatred turns once and for all into a rigidly and 
generally kind personality (618). 

A reaction formation may make use.of drives, the aims of which are opposite 
to the aims of the original drive. It may increase the strength of drives of this 
kind the better to hold the original drive in check, and in this way a conflict be- 
tween an instinctual impulse and an anxiety or a guilt feeling may be masked as 
a conflict between conflicting instincts. For example, a man may be reactively 
pregenital for the purpose of warding off genitality; another person may be re- 
actively (pseudo) genital to ward off pregenitality ; or reactively heterosexual to 
ward ofl homosexuality or vice versa; reactively passive-receptive to ward off 
aggressiveness or vice versa (1279). 

The fundamental diilerence between a reaction formation that suppresses an 
original impulse and a sublimation in which the original impulse finds discharge 
is not always clearly recognized in psychoanalytic literature. This is partly due to 
a contradictory terminology. The classification of attitudes according to whether 
the attitudes arc superseded or suppressed docs not necessarily coincide with the 
classification according to which the attitudes are subdivided into those that work 
in the same direction as the original impulse (or a slightly modified one) and 
those that are diametrically opposed. The following diagram may serve to clarify: 

Attitudes that work 


Attitudes by 
which the in- 
stinct is I. superseded 

11. suppressed 

We call I (which includes I A and IB) sublimation and II (which includes II A 
and IIB) reaction formation - The usual sublimation is represented by lA; but there 
is also the type of IB: for example, if in a normal person an original anal interest 
is replaced by a certain not too intense disgust for feces without an intense uncon- 
scious interest in feces remaining (555). The typical reaction formation would 
be represented by IIB; but there are also “counterphobic” attitudes of the category 
IIA in which doing the same thing one originally feared serves the purpose of 
holding the original intensive wish in check (435)* 

Sterba has advocated the contrary nomenclature. He wished to designate 
formations in which there is no trace of the original instinctual demand 
(IIB) as **true reaction formations,’^ thus including the origin of the super- 
ego among the reaction formations (i493)‘ Because in psychoanalytic ter- 


A. in the same or B. in the oppo- 
modified direction site direction 
as the original 
drive 

lA IB 

IIA IIB 



THE MECHANISMS OF DEFENSE 


153 


minology the term reaction formation has gained currency to designate for- 
mations due to countercathexis, we would prefer not to follow Sterba’s 
suggestion. 

To clarify the relation between reaction formation and sublimation let us com- 
pare {a) z child who learns to write well and enjoys it very much, {b) z child 
who has an inhibition for writing, {c) a child who writes very constrainedly and 
meticulously, and (<^) a child who smears. All of them have displaced anal-erotic 
instinctual quantities to the function of writing. In the first child a sublimation 
has taken place; he no longer wishes to smear but to write. The other children 
have not succeeded in channelizing this impulse. They are forced to inhibit it 
through a countercathexis, or to “robot’' through reaction formations, or even 
to retain the original impulse in an unchanged way. 

Whereas the sublimation of any instinctual demand into an ego function in- 
creases the effectiveness of this function, a reaction formation against a “sex- 
ualized” function necessarily decreases it. 

Sublimation is related to reaction formation in the same way that the successful 
construction of the superego is related to an immutable repression of the Oedipus 
complex. 

It is sometimes stated that sublimation is necessarily a kind of repression; the 
painter who has sublimated his smearing impulse does not consciously know any- 
thing about his anal eroticism. This depends on the definition of repression. If 
the disappearance of the original aim from consciousness is called repression, 
every sublimation is a repression (a “successful" one: through the new type of 
discharge, the old one has become superfluous). If, however, the definition of 
repression includes the conception of a continuous countercathexis, repression 
and sublimation exclude each other. For the man who has repressed his smearing 
impulses by a countercathexis, the idea of painting would have to be repressed, too, 
because it is too similar to the original smearing. However, there are neurotic 
artists whose productions are mixtures of sublimations and neurotic symptoms. 

UNDOING 

There arc no sharp lines of denaarcation between the various forms of defense 
mechanisms. Reaction formation was related to repression, and undoing (618) 
is related to reaction formation. In reaction formation, an attitude is taken that 
contradicts the original one; in undoing, one more step is taken. Something posi- 
tive is done which, actually or magically, is the opposite of something which, 
agaiii actually or in imagination, was done before. 

This mechanism can be most clearly observed in certain compulsive symptoms 
that are made up of two actions, the second of which is a direct reversion of the 
first (567). For example, a patient must first turn on the gas jet and then turn it 
off again. All symptoms that represent expiations belong in this category, for it 
is the nature of expiation to annul antecedent acts. The idea of expiation itself 
is nothing but an expression of belief in the possibility of a magical undoing. 

Paradoxically, the undoing sometimes does not consist of a compulsion to do 
the opposite of what has been done previously but in a compulsion to repeat the 



^54 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


very same act. Analysis shows that this is based on the following unconscious 
intention. The first act was done in connection with a certain unconscious in- 
stinctual attitude; it is undone when this same act can be repeated once more 
under other inner conditions. The aim of the compulsion to repeat is to carry out 
the very same act freed of its secret unconscious meaning, or with the opposite 
unconscious meaning. If, because of the continued effectiveness of the repressed, 
some part of the original impulse insinuates itself again into the repetition which 
was intended as an expiation, a third, fourth, or fifth repetition of the act may 
become necessary {cf,Si). 

An irreligious patient who obsessively had to pray for the health of his sick 
mother had the further compulsion of slapping his mouth lightly after having said 
the prayer. This was an undoing of the warding-off symptom, a return of the 
warded- off death wish toward the mother which meant: “I am putting the words 
of prayer back into my mouth.” The same mechanism is operative in children 
who think that a false oath is permissible if, while making the gesture of the 
oath with their right hand, they secretly make the opposite gesture with the left 
hand. 

Another patient suddenly felt a compulsion to crane his neck upward. It turned 
out that, shortly before, he had been riding down in an elevator and had thought 
that the rapid downward movement might have injured his brain (a disguised 
castration anxiety, “displaced upward”). The symptom of craning the neck up- 
ward was an “undoing”: the upward motion of the head was intended to throw 
the brain back to the place from which it slipped, and thus to annul the previous 
castration. 

This symptom represents a special case of the frequent type of compulsive 
symptoms that are based on the magic of symmetry and that often have the 
unconscious meaning of undoing. If anything has been touched on the right side, 
a similar object has to be touched on the left side. The meaning is that the equi- 
librium between instinct and counterinstinct should not be disturbed. If k has 
been disturbed on one side of the scale, it has to be “undone” on the other. The 
“number magic” of compulsion neurotics makes them prefer even numbers be- 
cause they do not disturb the equilibrium as odd ones do {see p. 288) . 

Often an intention to “undo” fails because what has been warded off returns 
in the very measure of warding off; “undoing” turns into “doing it again.” This 
happens when the undoing consists in performing the very same act but with an- 
other attitude; instead it may be repeated with the same attitude. An example: A 
patient with scruples in regard to the unnecessary expenditure of money bought 
a newspaper for a nickel; unconsciously to him this was equivalent to a visit to a 
prostitute. He regretted it and, wishing to undo the act, decided to return to the 
newsstand. He was uncertain what to do because he would have been ashamed to 
return the paper to the boy and to ask for the money. Then it occurred to him 
that the purchase of a second paper might ease his mind. But the stand was al- 
ready closed. Thereupon he took another nickel out of his pocket and threw it 
away. 



THE MECHANISMS OF DEFENSE 


155 


Like reaction formation, the defense mechanism of undoing may be brought 
about by a reactive increase in the strength of a drive opposed to the original 
drive, thus condensing the defensive attitude with an instinctual attitude striv- 
ing for erogenous pleasure. When a child experiences defecation as a loss of 
his narcissistic integrity and develops a tendency for compensating coprophagy 
(or, later, when the adult indulges in reading while on the toilet), this coproph- 
agy represents both an undoing of the defecation and an oral-anal pleasure. 
When a person with castration anxiety regresses to the anal level and substitutes 
the idea of losing feces for the idea of losing the penis, the frequent repetition 
of defecation gives reassurance that the loss is not permanent; while the ego “is 
concerned in undoing the castration . . . the id by the same process is indulging 
in anal impulses” (1054). This possibility of simultaneous reassurance and pleas- 
ure is probably the explanation for the fact that the mechanism of undoing is so 
often applied in conflicts around anal eroticism. 

A special significance is connected with actions and attitudes aimed at the un- 
doing of imaginative destructions. Strivings for reparation may or may not be 
successful in holding sadistic drives in check. They may be the main motive for 
artistic or scientific sublimations (1422, 1424) as well as for painful compulsive 
rituals (895, 959). 

A failing of the mechanism of undoing, due to the invasion of the defense 
by the warded-off impulses, explains several phenomena frequent in compulsion 
neurosis: (a) the increase in the number of necessary repetitions because no rep- 
etition gives complete reassurance that this time it is done without the instinctual 
intention, (i) some forms of counting compulsions, the unconscious meaning of 
which is to count the number of necessary repetitions, (c) the ever broadening 
scope of the ceremonial assurances, (d) obsessive doubts which sometimes are 
doubt as to whether the undoing has succeeded, and finally, in certain cases, 
(e) the futility of all these measures (see pp- 306 £[.). 

ISOLATION 

Another mechanism of defense prevalent in compulsion neuroses and of very 
general significance for psychopathology is isolation (618). Here the patient has 
not forgotten his pathogenic traumata, but has lost trace of their connections and 
their emotional significance. He shows the same resistance to a demonstration of 
the true connections that a hysteric shows to the reawakening of his repressed 
memories. Thus here again a countercathexis is operative; its operation consists 
in keeping apart that which actually belongs together (1000). 

Sometimes the patient interpolates real spatial or temporal intervals between 
the two realms that are supposed to be kept separate. Spatial intervals are ar- 
ranged so that certain things (representing ideas that are to be kept apart) can- 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


156 

not touch each other, or a certain order is assigned to them which maintains a 
distance between them. Temporal intervals are planned so that after an action 
there is an intermission keeping the act from impinging upon any other one. 
Measuring such temporal intervals is sometimes one of the determinants of a 
neurotic compulsion to count. 

Of practical importance is the patient who hinders any therapeutic effect of 
his analysis by carrying on the whole analysis “in isolation.” The analysis is ac- 
cepted only as long as the patient lies on the couch, but remains isolated from 
the rest of his life. Sometimes such patients have to begin and end the analytic 
hour with certain rituals, which serve to isolate the analytic sessions from what 
occurs before and after (^38). 

The most important special case of this defense mechanism is the isolation of 
an idea from the emotional cathexis that originally was connected with it. In dis- 
cussing the most exciting events, the patient remains calm but may then develop 
at quite another point an incomprehensible emotion, without being aware of 
the fact that the emotion has been displaced. Extremely objectionable ideational 
contents, like murder or incest wishes, may become conscious in the form of 
obsessions, because the obsessional neurotic is able to feel these ideas as mere 
thoughts, securely isolated from motility. The emptiness of affect, which is so 
characteristic for certain compulsion neurotics and which creates a serious dif- 
ficulty in treating them, is based on an isolation of this type. Certain patients are 
even able to feel their emotions fully, but only as long as they can somehow pre- 
tend to be merely playing or to be making thought experiments or the like, that 
is, as long as the emotions remain isolated from “seriousness.” 

Compulsive patients withdraw from the frightening experiences of emotional 
impulses into the “isolated” world of words and conceptions. In obsessive brood- 
ing, the repressed returns: involuted philosophical ideas, which were intended as 
a protection against instinctual impulses, become as highly important emotionally 
as instinctual impulses arc for the normal person {see p. 297). 

An isolation that occurs very frequently within our culture is that of the sen- 
sual and the tender components of sexuality (572). It is a consequence of the 
repression of the Oedipus complex that many men (and also quite a number of 
women) do not succeed in attaining full sexual satisfaction because sensuality 
can be enjoyed only with persons toward whom they have no tender feelings or, 
even, toward whom they have contemptuous feelings or none at all. “They can- 
not desire where they love, and they cannot love where they desire” (572). The 
institution of prostitution gives men of this type an opportunity to isolate their 
objectionable sensuality from the rest of their life, and thus relieves them of the 
necessity to repress it. 



THE MECHANISMS OF DEFENSE 


157 


Many children try to solve conflicts by isolating certain spheres of their lives, 
from one another, such as school from home, or social life from the secrets of 
their loneliness; one of the two isolated spheres usually represents instinctual 
freedom and the other good behavior. They even split their personality and state 
that they are two children with different names, a good one and a bad one, and 
deny the good one’s responsibility for the bad one’s deeds. 

Whether the famous cases ^of “dual personality” should be called isolations or 
repressions depends upon whether or not the person in one state knows about the 
existence of the other state. These cases show that isolation and repression are 
basically related to each other. 

Also in the cases which Freud called “split of the ego” (621, 633, 635) an un- 
pleasant knowledge is kept isolated from the rest of the personality. 

Another type of isolation is represented by attempts to solve conflicts around 
ambivalence— that is, conflicts between love and hatred of the same person— by 
splitting the contradictory feelings so that one person is only loved, another one 
only hated, a countercathexis preventing the two feelings from having contact 
with each other. An example is the contrast of the good mother and the wicked 
stepmother in fairy tales (552). 

Failure of an attempt at isolation can be seen in the frequent obsessive blas- 
phemies. In order to isolate the awe-inspired positive attitude toward the father 
figure from all aggressive of sensual ideas, a religious attitude was intended; in 
the obsessive blasphemies, this intention fails. 

Although isolation occurs in all cases of compulsion neurosis, there are some 
persons in whom this mechanism dominates the picture to such an extent that 
they offer excellent demonstration material of this mechanism. The following 
case (41 1 ) illustrates this point. 

A young man of seventeen became neurotic as a result of his conflict about 
masturbation. For a time he masturbated without any guilt feeling and often also 
watched when his schoolmates indulged in mutual masturbation. He then heard 
his minister deliver a sermon, advising against association with anyone who mas- 
turbated. Since in childhood the patient’s genitality had been inhibited by an ex- 
cessive fear of castration, he took the minister’s sermon to heart and decided to 
follow his advice and no longer speak to boys who masturbated. This had particu- 
lar reference to a boy who, he knew, masturbated a great deal. For a while he suc- 
ceeded in keeping his resolution. But then to avoid contact with the hoy, he 
developed certain phobias and compulsive procedures to maintain the avoidance. 
First, whenever he met the boy, he had to spit; an obsessive decree about the 
number of times he had to spit was never clarified in analysis. The phobia spread; 
he refrained from any contact with the family and friends of “The Avoided 
One,” (The patient gave the boy this title in order to avoid using his name.) 
Then, because the avoided one was the son of a barber, the patient kept away from 
barbershops. Later he even avoided contact with persons who let themselves be 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


158 

shaved by barbers, and found it imperative to stay away from the section of the 
city where the barbershop of the boy’s father was situated. 

And then the entire neurosis developed quickly into an “isolation neurosis.” He 
made the compulsive stipulation that the members of his family, particularly the 
women, which meant his grandmother, mother, and sister, were not to go into 
the forbidden neighborhood. He suffered greatly because his relatives would not 
accept this restriction of their freedom. He himself followed his own prohibition 
implicitly; but the more stringently he limited his actions, the more intensely was 
he forced obsessively to thin\ of the forbidden section of the city. It is easy to 
understand that this caused him pain. But he gave an unexpected explanation of 
the pain. It was painful, he said, because at home he saw his mother and grand- 
mother, and therefore ought not to think of the forbidden localities or persons. 
Although he was aware of the relation between his illness and masturbation, he 
ignored the connection. His masturbation had been given up without much 
apparent difHculty. But in its stead, the neurotic effort to keep the idea of “member 
of the family” separated from “uncongenial persons and localities,” to isolate them 
from each other, became more and more definite. 

This isolation became the chief topic of the neurosis. The patient allowed him- 
self to think of “uncongenial “things” but tried to avoid thinking of “congenial” 
persons at the same time. He thus demonstrated that the Oedipus complex was 
the content of his masturbation. The elaboration of this effort on the part of the 
ego to defend itself against the Oedipus complex by means of isolation led in a 
few months to a compulsion neurosis of the severest type. 

The patient was like the man in Wedekind’s play who was not supposed to 
think of a bear. Whenever the patient thought of the avoided one he immediately 
thought of his grandmother. This tormenting symptom he called connecting. He 
was able to use a defense to deal with it, namely, a so-called disconnecting, which is 
a good example for an “undoing” mechanism. After he had simultaneously 
thought of a forbidden locality and a congenial person, if he could form a mental 
picture of the uncongenial thing, completely isolated and freed from all congenial 
adjuncts, everything was set right again, and he was quieted. Before long, the pa- 
tient was absorbed in making “disconnections” from morning till night. 

Two other components which tend to increase the severity of a spreading com- 
pulsion neurosis then appeared: an immense extension of the field of symptoma- 
tology, and an invasion of the symptoms by the warded-off impulses. 

The division of objects into congenial and uncongenial ones gradually embraced 
all persons and all localities. Thus “schoolmates” became “uncongenial,” “rela- 
tives” became “congenial”; but also all other persons, through superficial associa- 
tions, were placed in one category or the other and so were subject to connec- 
tions and disconnections. 

After having undergone a connection, he could not leave the place where he 
happened to be, nor could he interrupt the activity that engaged him at that mo- 
ment, until he had completed disconnecting. This condition was most distressing 
to him. Thus it was always problematic whether he would be able to rise from 
the couch after his analytic hour, and he would be tortured throughout the hour 
by the fear that it might end just between a connection and a disconnection. 
Finally, the defense itself came to give expression to the rejected impulses. The 
compulsion to disconnect made it necessary for the patient to have a suJfficient 



THE MECHANISMS OF DEFENSE 


159 


number of congenial persons, places, and things in constant readiness. The desire 
to put a quick end to the tormenting tension brought about a return of the re- 
pressed from the repression. The patient frequented uncongenial places and took 
careful notice of uncongenial persons, so that he might have them in readiness 
in case he needed them. However, he was not able to do this with all uncongenial 
objects. The avoided one, for example, remained avoided. In time he had a gradu- 
ated series of differentiations. There were objects that were phobically avoided 
as completely uncongenial; then there were less uncongenial ones searched for 
which he had to have in readiness; then somewhat indifferent ones, slightly con- 
genial ones, and completely congenial ones. He finally consciously exerted himself 
to think of uncongenial objects only, hoping that he would then more easily bring 
about the disconnection. Since the thought “uncongenial objects” stood for “mas- 
turbation,” he now was unconsciously masturbating continually. And in point of 
fact, when his tension was greatest and he could not make a disconnection in spite 
of all his effort, he would occasionally, to his great astonishment, have an ejacula- 
tion. 

Freud has drawn attention to a normal prototype of isolation and to a point 
relating to its origin (618) . 

The normal prototype is the process of logical thinking, which actually con- 
sists of the continued elimination of affective associations in the interest of ob- 
jectivity. Compulsion neurotics, in their isolation activities, behave like carica- 
tures of normal thinkers. This throws light on a factor of importance in analytic 
therapy. Free association appears to be essentially a suspension of the normal 
isolating countercathexes. The isolations that characterize normal thinking are 
supposed to be suspended by the injunction to express whatever comes to mind, 
so that the original unconscious connections may reappear. Since compulsion 
neurotics invest a considerable part of their countercathexes in the special mecha- 
nism of isolation, they find it diSBcult to associate freely. Indeed, some compul- 
sion neurotics never learn to do so. They always desire order, routine, system. 
From the psychological point of view, this means that they do not wish to dis- 
pense with their isolations. 

Genetically, the mechanism of isolation is related to the ancient taboo of 
touching. Threshold rituals and paving-stone compulsions express conflicts as 
to whether or not to obey this taboo (30, 390) . The taboo of touching, as the pro- 
totype for the mechanism of isolation, may be directed against any instinctual 
impulse. There are no forbidden impulses, whether of a sensual, aggressive, or 
tender nature, the aim of which would not presuppose a touching of the object. 

REGRESSION 

The concept of regression was discussed previously {see pp. 53 and 65). When- 
ever a person meets a frustration, there is a tendency for him to long for earlier 
periods in his life when his experiences were more pleasant, and for earlier types of 
1 satisfaction that were more complete. The intensity of this tendency increases with 



l6o XHE PSYCHOANALYTIC THEORY OF NEUROSIS 

two factors which are closely interrelated: the degree of hesitancy with which 
the individual accepts newer modes of satisfaction and the degree to which he is 
fixated to earlier types. Can regression, in this sense, be called a mechanism of 
defense? 

The typical compulsion neurotic, experiencing a conflict between his phallic 
Oedipus wishes and his castration fear, substitutes anal-sadistic wishes for his 
Oedipus demands. Thus, actually, regression is a means of defense (6i8). What 
must be admitted, however, is that the part played by the ego in regression is dif- 
ferent from the part it plays in all other defense mechanisms. Other defense 
mechanisms are set in motion by an activity of the ego (although in this activity 
the ego may use more archaic and automatic mechanisms) ; in regression the ego 
is much more passive. Regression happens to the ego; in general, regression seems 
to be set in motion by the instincts which, blocked from direct satisfaction, seek 
a substitute. The precondition for the use of regression as a mechanism of de- 
fense is, therefore, a peculiar weakness of the ego organization {see p. 305). 

It has been mentioned that there is a complementary relation between fixation 
and regression; it is easy to give up something that is not very important. The 
more intense the pregenital fixations, the weaker the subsequent phallic organ- 
ization. An individual fixed on the anal level will advance only with reluctance 
to the phallic phase, and he will always be prepared to relinquish his new acqui- 
sition upon slight disappointment or threat. However, very intense and sudden 
disappointments and dangers may provoke regressions even in individuals with- 
out strong fixations. 

Two types of regression deserve special mention. The first is regression from 
adult forms of sexuality to infantile ones. This regression is the prerequisite of 
neuroses. Any disappointment in or threat to adult sexuality may influence a 
person to revert to those levels of his infantile sexuality to which he is uncon- 
sciously fixated; in other words, to levels that have been repressed and remained 
unchanged in the unconscious. However, a neurosis develops only if this mobi- 
lization of infantile sexuality in turn brings about a remobilization of the old 
conflicts which once in childhood raged around infantile sexuality. The re- 
gression to infantile sexuality may be limited to the leading erogenous zone, so 
that, for instance, a hysterical, orally fixated person may express his genital 
Oedipus wishes in fantasies of fellatio or in oral symptoms. Or there may be 
a full regression in which not only the consummation of genital wishes may 
be expressed in a prcgcnital way but also the whole complex of pregenitality, 
including such characteristics as ambivalence and bisexuality, replaces gcnital- 
ity. In this sense, the typical compulsion neurotic has given up his genitality and 
has become anal sadistic once more {see pp. 274 £[.). 

The second special case of regression is the regression to primary narcissism, 
or to the stage of development before the final differentiation of ego and id. If 



THE MECHANISMS OF DEFENSE 


l6l 


this deepest regression occurs, it is a resumption of the very oldest type of de- 
fense — blocking of the ego. 

What determines the choice of types of defense mechanisms will be discussed 
later {see pp. 523 ff.) . 

DEFENSES AGAINST AFFECTS 

So far, discussion has been confined to the mechanisms of defenses against 
instinctual drives. Instinctual drives are warded off, however, because of anxiety 
or guilt feeling, that is, to avoid the pain of traumatic panic or of loss of self- 
esteem. Thus in the last analysis any defense is a defense against affects. 'I do not 
want to feel any painful sensation” is the first and final motive of defense (589, 
590). Although the more organized defenses against instinctual drives are of 
greater importance in the psychogenesis of neuroses, it should not be forgotten 
that archaic, less systematic defenses against affects are operative, too. Even the 
experience of anxiety or guilt feeling, which motivates defense against instinctual 
drives, is painful, and actually there are defenses that tend not to avoid instinctual 
actions or situations of temptations or punishment but that tend directly toward 
the avoidance of the very feeling of anxiety or guilt. This is especially marked in 
certain archaic character formations where large-scale defenses against anxiety 
may be observed (see pp. 479 flE.). 

BLOCKINTG (REPRESSION) OF AFFECTS 

It appears that the ego, having once been overwhelmed by affects, can regain 
its strength to such an extent that in similar recurring situations it may have 
adequate countercathexes on hand to ward off a new complete development of 
the affect. We may speak of unconscious affects as well as of unconscious sensa- 
tions; in both instances there are certain states of tension which, were they not 
hindered in their development and discharged by countercathexis, would result 
in affects and sensations respectively, unconscious strivings toward the develop- 
ment of affects, which are held in check by opposing forces. “Unconscious sexual 
excitement” or “unconscious anxiety” can be observed clinically in the same 
way as unconscious material can be observed in general; the blocked uncon- 
scious dispositions toward affects develop derivatives, betray themselves in 
dreams, in symptoms, and in other substitute formations; they betray them- 
selves merely in a general weakness which is caused by excessive consumption 
of energy (590, 608) . “Emotional frigidity” (seepp. 477 ff.) and certain types of de- 
personalization (seepp. 419 L) are examples of general emotional blocking. It has 
been said that a disproportion between the precipitating factor and the affect reac- 
tion is an index of the presence of repressions; it may be added that, through the 
development of derivatives, a general affective instability is the first consequence 
of affect defense through the blocking of discharge. The person may have learned 



i 62 


THE PSYCHOANA.LYTIC THEORY OF NEUROSIS 


to defend himself secondarily against this instability by strengthened counter- 
cathexes. If aifcctive instability is the first result of affect defenses, general affective 
rigidity is the second. 


POSTPONEMENT OP AFFECTS 

The simplest derivatives are the delayed outbursts of affects. The temporal 
displacement, resulting simply in a later appearance of the affect reaction and 
in thus preventing the recognition of the motivating connection, is the most fre- 
quent special case of affect displacement. This type of defense is most frequently 
instituted against the affects of rage (or annoyance) and grief. Rage can obvi- 
ously be endured without discharge for a short period, but for a short period 
only; then it must be released, no matter against whom. In the affect of grief, 
postponement seems to be an essential component. What happens in mourning 
is nothing other than a gradual “working through” of an affect which, if re- 
leased in its full strength, would overwhelm the ego, that is, the quantity of 
cathexes released by the loss of the object. What today is called grief is obviously 
a postponed and apportioned neutralization of a wild and self-destructive kind 
of affect which can still be observed in a child’s panic upon the disappearance 
of his mother or in the uninhibited mourning reactions of primitives (597, 1640) 
{see p. 394) . Hence it is understandable that the mechanism of affect postpone- 
ment has been studied with special reference to the phenomenon of grief. Freud’s 
patient “wolf -man” did not show any reaction upon the death of his sister, but 
burst into tears at Pushkin’s grave (599). Helene Deutsch has devoted a paper 
to this question (332). 

Postponement of affect is, however, by no means limited to rage and grief. 
Pfister investigated the reaction of the ego to acute mortal danger and repeatedly 
found an absence of fear during the period of acute danger, but a subsequent 
appearance of intense fear when the danger was past (1225), Such postponement 
of fear may have a lifesaving effect because it makes possible purposeful action 
which otherwise might have been paralyzed by the fear. Similarly, the anxiety 
symptoms of traumatic neurotics represent in part such delayed fear. A “de- 
layed fright” sounds like a contradiction, because fright is a sudden and immedi- 
ate reaction. And yet there is such a thing. Frightful experiences may be calmly 
accepted by the person in question, who is, however, engulfed by fright some 
moments later. During these moments, the ego has been able to prepare itself, to 
protect itself from being completely overwhelmed. 

The postponement of fright is so well known to movie writers that it is not only 
frequently used but also designated by a special term: double-take. It is illustrated 
by the anecdote according to which a man comes home after a strenuous day of 
work and finds a telegram about the death of a relative, reads it while going to 
bed and then exclaims: “Oh, what a terrible shock this will be in the morning I” 



THE MECHANISMS OF DEFENSE ^^3 

Not infrequently, postponed reactions of shame and disgust can be observed. 

A patient had, in the course of his analysis, resumed the infantile habit of anal 
masturbation. In his analysis he explained that in so doing he had soiled his 
fingers. It was striking that he showed no disgust reaction, although his character 
would have led one to expect it. A few days later, he reacted to a relatively slight 
provocation with a disproportionately strong outburst of disgust. 

The delay of reactions of fatigue while under stress, until the danger is over, 
apparently is based on the same mechanism. 

Sometimes, after the endurance of great pain or of severe strain, a kind of 
apathy, of loss of sensitiveness to pain, and of frigidity toward feelings can be 
observed. This, too, must be due to a similar mechanism, protecting the ego 
against affects or sensations that would be overwhelming. 

DISPLACEMENT OF AFFECTS 

Postponement is but one special case among many types of displacement of 
affects (552) . Another subtype is displacement in respect to the object. The af- 
fect, which was suppressed in relation to one object, bursts forth against another 
object. This type of displacement may be combined with postponement as in the 
case of the wolf-man’s reaction at Pushkin’s grave (599). The displacement of 
the feared object is known from animal phobias (566). 

AFFECT EQUIVALENTS 

The defense is more successful if the person can deceive himself as to the char- 
acter of his own emotion. The typical discharge innervations may occur, wholly 
or partially, but their psychic significance remains unconscious. This is the way 
in which the so-called affect equivalents originate (see pp, 237 f,). Anxiety equiva- 
lents were described by Freud in his earliest work on anxiety neuroses (545, 547). 
Equivalents of mourning were collated by Landauer (loii). It cannot be doubted 
that all other affects can likewise be replaced in a similar way by equivalents of so- 
matic sensations. It is characteristic of certain compulsive personalities that when 
analysis has successfully attacked their affect blocking, they begin to complain 
of certain changes in body sensations, without realizing their psychic signifi- 
cance. Before they can again experience the affects fully, they first find the road 
to affect equivalents. Schreber’s somatic ‘'basic language” (574) consists of affects 
reduced to body sensations. 

REACTIOTSr FORMATIONS AGAINST AFFECTS 

The denial of the true significance of an affect may be increased to a compul- 
sive adherence to the opposite emotional attitude. Impudence may be developed 
as a defense against feelings of guilt, courage as a defense against fear, 



i 62 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


to defend himself secondarily against this instability by strengthened counter- 
cathexes. If affective instability is the first result of affect defenses, general affective 
rigidity is the second. 


POSTPONEMENT OF AFFECl’S 

The simplest derivatives are the delayed outbursts of affects. The temporal 
displacement, resulting simply in a later appearance of the affect reaction and 
in thus preventing the recognition of the motivating connection, is the most fre- 
quent special case of affect displacement. This type of defense is most frequently 
instituted against the affects of rage (or annoyance) and grief. Rage can obvi- 
ously be endured without discharge for a short period, but for a short period 
only; then it must be released, no matter against whom. In ihc affect of grief, 
postponement seems to be an essential component. What ha[')pens in mourning 
is nothing other than a gradual ^‘working through” of an alTect which, if re- 
leased in its full strength, would overwhelm the ego, that is, the quantity of 
cathexes released by the loss of the object. What today is called grief is ol)vioiisly 
a postponed and apportioned neutralization of a wild and sclf-clcstrLictivc kind 
of affect which can still be observed in a child's panic upon the disappearance 
of his mother or in the uninhibited mourning reactions of primitives (5CJ7, 1640) 
(see p, 394). Hence it is understandable that the mechanism of affect postpone- 
ment has been studied with special reference to the phenomenon of grief. Freud's 
patient “wolf-man” did not show any reaction upon the death of his sister, but 
burst into tears at Pushkin’s grave (599). Helene Deutsch has devoted a paper 
to this question (332). 

Postponement of affect is, however, by no means limited to rage and grief. 
Pfister investigated the reaction of the ego to acute mortal clanger and rc[^catcdly 
found an absence of fear during the period of acute danger, but a subsequent 
appearance of intense fear when the danger was past (1225). Such postponement 
of fear may have a lifesaving effect because it makes possible purposeful action 
which otherwise might have been paralyzed by the fear. Similarly, the anxiety 
symptoms of traumatic neurotics represent in part such delayed fear. A “de- 
layed fright” sounds like a contradiction, because fright is a sudden and immedi- 
ate reaction. And yet there is such a thing. Frightful experiences may be calmly 
accepted by the person in question, who is, however, engulfed by fright some 
moments later. During these moments, the ego has been able to prepare itself, to 
protect itself from being completely overwhelmed. 

The postponement of fright is so well known to movie writers that it is not only 
frequently used but also designated by a special term: double-take. It is illustrated 
by the anecdote according to which a man comes home after a strenuous day of 
work and finds a telegram about the death of a relative, reads it while going to 
bed and then exclaims: “Oh, what a terrible shock this will be in the morning!” 



THE MECHANISMS OF DEFENSE 


1 6^ 


Not infrequently, postponed reactions of shame and disgust can be observed. 

A patient had, in the course of his analysis, resumed the infantile habit of anal 
masturbation. In his analysis he explained that in so doing he had soiled his 
fingers. It was striking that he showed no disgust reaction, although his character 
would have led one to expect it. A few days later, he reacted to a relatively slight 
provocation with a disproportionately strong outburst of disgust. 

The delay of reactions of fatigue while under stress, until the danger is over, 
apparently is based on the same mechanism. 

Sometimes, after the endurance of great pain or of severe strain, a kind of 
apathy, of loss of sensitiveness to pain, and of frigidity toward feelings can be 
observed. This, too, must be due to a similar mechanism, protecting the ego 
against affects or sensations that would be overwhelming. 

DISPLACEMENT OF AFFECTS 

Postponement is but one special case among many types of displacement of 
affects (552). Another subtype is displacement in respect to the object. The af- 
fect, which was suppressed in relation to one object, bursts forth against another 
object. This type of displacement may be combined with postponement as in the 
case of the wolf-man’s reaction at Pushkin’s grave (599). The displacement of 
the feared object is known from animal phobias (566). 

AFFECT EQUIVALENTS 

The defense is more successful if the person can deceive himself as to the char- 
acter of his own emotion. The typical discharge innervations may occur, wholly 
or partially, but their psychic significance remains unconscious. This is the way 
in which the so-called affect equivalents originate {see pp. 237 f.). Anxiety equiva- 
lents were described by Freud in his earliest work on anxiety neuroses (545, 547), 
Equivalents of mourning were collated by Landauer (roii). It cannot be doubted 
that all other affects can likewise be replaced in a similar way by equivalents of so- 
matic sensations. It is characteristic of certain compulsive personalities that when 
analysis has successfully attacked their affect blocking, they begin to complain 
of certain changes in body sensations, without realizing their psychic signifi- 
cance, Before they can again experience the affects fully, they first find the road 
to affect equivalents. Schreber’s somatic “basic language” (574) consists of affects 
reduced to body sensations. 

REACTION FORMATIONS AGAINST AFFECTS 

The denial of the true significance of an affect may be increased to a compul- 
sive adherence to the opposite emotional attitude. Impudence may be developed 
as a defense against feelings of guilt, courage as a defense against fear. 



164 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

We are accustomed to shame and disgust being used as sexual defenses. Thus 
we are prone to regard strikingly shameless behavior, or an ostentatious recourse 
to the disgusting, as an eruption of infantile sexual instincts rather than as a 
reaction formation against affects. But such an “eruption of instincts” is not nec- 
essarily simply constructed. Editha Sterba’s analysis of a “shameless girl” showed 
that at least in this case there was not a definite lack of shame but a complicated 
reaction formation against a preceding period strongly characterized by intense 
shame (i486). The “counterphobic attitudes” (435) are reaction formations 
against anxiety {see pp. 480 ff.). 

Change of Quality of Affects 

It is also conceivable that the effect of defense mechanisms of the ego specifi- 
cally changes the quality of affect experiences. Freud’s old conception that under 
certain conditions sexual excitement is transformed into anxiety (551, 558) 
has not yet been refuted. 

Isolation of Affects 

Affects may be isolated from their entire psychic connections by a special ex- 
penditure of countercathexis. The analysis of affect disturbances consists largely 
in the re-establishment of connections that have been lost through distortions of 
this kind. Sometimes certain affect excitations are admitted only under certain 
conditions which unconsciously mean some reassurance against danger, but not 
under others, for instance, only so long as no real or serious character is ascribed 
to them. 

Projection and Introjection of Affects 

Affects may be projected, that is, perceived in someone else, to avoid perceiving 
them in oneself. The idea of an introjection of an affect seems to make no sense. 
However, the expression to swallow one’s emotion should be taken into consid- 
eration. Undoubtedly there is an affect defense through introjection of the object 
against. whom the affect was directed, as, for example, the mechanism of “iden- 
tification with the aggressor” when an object is feared (541). 

Like all defenses, defenses against affects may fail. Persons who deny their 
affects may, under some conditions, be completely overwhelmed by the return 
of their affects. Hence affect defenses frequently show a double-edged character; 
the absence of affect may be reversed into an attack of affect; an affective attitude 
of the nature of a reaction formation may be reversed into the original opposite 
affect. 

Defenses against Guilt Feelings 

There is a group of defenses against affect that deserve special attention be- 



THE MECHANISMS OF DEFENSE 


165 

cause of their clinical importance : the defenses against guilt feelings. They are 
characteristic for certain types of neuroses in which the ego is compelled to estab- 
lish a double countercathexis and to struggle against objectionable id wishes and 
superego demands simultaneously. 

Guilt feelings may be repressed. Frequently rationalizations as to the necessity 
of committing a forbidden deed secure a repression of guilt feelings. Macbeth’s 
belief in the witches’ prophecy is an attempt to convince himself that the murder 
was necessary, and that he does not have to feel guilty about it. His realization 
that he has misunderstood the prophecy, when it is too late, represents the return 
of the repressed guilt feeling from the repression (442). 

Frequent in occurrence are attempts at projecting guilt feelings. '‘Someone else 
has done it, not I” is the leitmotiv of many a neurotic character. 

There are different types of quasi-projections of guilt feelings. Any guilt can 
be borne more easily if someone else has done the same thing. For the sake of 
the feeling of relief that can thus be attained, persons who either have done some- 
thing about which they feel guilty or wish to do such a thing are searching for 
another person in the same situation; they feel greatly relieved if they succeed 
in folding anyone who does or has done the same deed. They may even provoke 
other persons to do things about which they feel guilty. The relieving function 
of sharing the guilt is one of the basic factors in the psychology of art. The artist 
relieves his guilt feeling by inducing the audience to participate in his deed in 
fantasy, and the spectator relieves his guilt feeling by becoming aware that the 
artist dares to express forbidden impulses (1332). Similarly the motive for telling 
a joke always consists of an attempt to get the approval of the audience for the 
underlying guilt in the offensive impulses concealed in the joke (556, 1294). 
Sharing the guilt is also of basic importance in group formation (1258). 

Even if the guilt feeling is too intense to be overcome by sharing the guilt, a 
projection may still work in the form of a tendency to denounce tendencies in 
others which the person tries to deny in himself. This is the old story of the mote 
in the brother’s eye. 

At times the superego, which had its origin in the introjection of an external 
object, is reprojected onto external objects for the purpose of getting rid of guilt 
feelings. Compulsion neurotics often try to avoid a sense of guilt by appealing to 
others to forgive them. 

A compulsive patient used to relate his obsessive scruples at the beginning of 
the analytic hour and then would not associate to them. He eventually explained 
that his scruples had disappeared as soon as they were expressed. Since the analyst 
was not so infuriated or frightened as to fall out of his chair but listened, the 
patient felt free to assume that his scruples were trivial. 

Similar phenomena are very frequent in ordinary social life. The individual 
needs confirmation by others or the applause of an audience as signs of forgive- 



r66 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


ness. An external pardon achieves the same end as the seduction of another per- 
son to share in the guilt. 

The patient mentioned above had an obsessive need to read the newspaper 
aloud. He felt indignation at the many examples of injustice in the world, but he 
needed the company of another person who would share his indignation. His 
reading aloud was intended to mitigate his internal sense of guilt, the agreement 
of his listener justifying his own aggressive tendencies. 

Many forms of exaggerated need to communicate with others or of compulsive 
loquacity are variations of the same tendency. They originate in a need to gain the 
approval of other persons for something inwardly felt as prohibited. 

By provocation, seduction, ingratiation, and confession, the environment is 
drawn into the conflict between the ego and the superego, in the hope of obtain- 
ing some relief. Much of what is called object relationships are actually pseudo 
object relationships, in which the subject does not develop any feelings toward 
the object as a person but uses the object as an instrument for achieving relief 
in a conflict with his superego {see pp. 293 f., 496 ff., and 518 ff.). 

Can there be any such thing as an introjection of a guilt feeling? At first glance 
this seems to be impossible. However, the “borrowed” guilt feeling (608, 1005), 
created by identification with another person who is likewise supposed to feel 
guilty, may be used in assuagement of one’s own guilt feeling. 

Certainly there are many reaction formations to guilt feelings. People may 
behave extremely and provocatively nonchalant and carefree, may even be proud 
of “having no conscience scruples,” only to learn in analysis that their attitude 
needs a great amount of countercathexis to hold severe guilt feelings in check. 
Certain impulsive characters, by their unscrupulous behavior, protest against 
the intense pressure they feci from their very strict superego. In a less obvious 
manner, this may be the unconscious meaning of certain compulsive symptoms, 
the significance of which is a rebellion against the superego and the acquisition 
of proofs of innocence. 

An isolation of guilt feeling is a frequent occurrence in compulsion neurotics; 
they do things without any guilt feeling, and experience an exaggerated feeling 
of guilt on some other occasion without being aware of the connection (567), 
Also, impulsive psychopaths, who often are considered to have no superego at 
all (1603), reveal in analysis that they have temporarily isolated the demands of 
their superego, so that these demands are not effective when the “psychopath” 
gives in to his in^pulses (i?66) ( see pp. 374 f.) . 

Regression as defense against guilt feelings may be observed in the case of 
moral masochism, where conscience, which has its origin in the Oedipus com- 
plex, is sexualized again and used as an occasion for distorted gratification of 
Oedipus wishes (613). A certain kind of regression is effective also in less ex- 
treme cases where the reaction to the superego is to resume, in some transference 



THE MECHANISMS OF DEFENSE 167 

action, the type of behavior which had previously been shown toward the par- 
ents in order to achieve forgiveness or punishment. 

Actually, defensive conflicts are more complicated than this description indi- 
cates. An isolated conflict between one particular drive and one particular op- 
posing anxiety rarely occurs. More frequently there are complex and powerful 
interactions between many drives and many anxieties. A defensive struggle is 
rarely brought to a successful conclusion by one particular defensive activity. 
Defenses may be more or less successful; they may work under certain circum- 
stances and be insufficient under others. All the minutiae of everyday life are 
perceived either as temptations for repressed impulses or as warnings of possible 
punishments, and may thus disturb the equilibrium anew. Certain experiences 
may evoke the return of what has been warded off in the defense, which may in 
turn necessitate defenses against the defenses. There are reaction formations 
against reaction formations. Conditions favorable and opposed to the objection- 
able irnpulses arise, so that many contradictory layers develop; however, the 
layers are not placed evenly one above the other but are full of rifts. Throughout 
the development of the individual, both progression and regression are operative. 
The actual picture is confusing until analysis succeeds in separating the layers 
historically. Here only a description has been given of the individual mecha- 
nisms by which the separate layers are constructed. 



Chapter X 

THE DIRECT CLINICAL SYMPTOMS OF THE 
NEUROTIC CONFLICT 

CLASSIFICATION OF THE DIRECT CLINICAL SYMPTOMS OF THE 
NEUROTIC CONFLICT 

The neurotic conflict is not yet a neurosis. However, the effectiveness of the 
conflict manifests itself in certain pathological phenomena, which nevertheless 
are also frequently called neurotic. 

The clinical symptoms of the neurotic conflicts are either direct expressions 
of the activities of the defensive forces, that is, manifestations of the countcr- 
cathexis, or symptoms arising from the relative insuiScicncy of the ego in the 
state of being dammed up. 

The activity of the defensive forces may manifest itself in various ways. First 
of all, the anxieties or guilt feelings motivating the defense may be conscious as 
such, though the person does not know what he feels afraid of or guilty about. 
Other manifestations of the countercathexis differ according to the mechanism 
of defense used. The results of denial and projection are manifest as such; intro- 
jection expresses itself in identification; repression shows itself in voids in the 
patient’s thoughts, feelings, memories, behavior patterns or in the intensity with 
which substitute formations are preserved; reaction formations betray them- 
selves by their rigid character, which is nevertheless often broken through; un- 
doing and isolation form certain compulsive symptoms; regression changes the 
wishes and behavior of the personality. All the pathogenic defenses, however, 
build up resistances against attempts to interfere with their operation. Some of 
the manifestations of defenses are regularly expressions of the warded-off forces 
at the same time; therefore they will be discussed in the chapters on symptom 
formation that follow. A pure manifestation of countercathexis, however, is pre- 
sented by specific avoidances and inhibitions of functions arising from a defense 
against these functions. 

The symptoms of the relative insufficiency of the ego created through the 
state of being dammed up are called actual-neurotic symptoms and are very 
similar to the symptoms in traumatic neuroses, since the decrease in discharge 
resulting from the defensive conflict creates the same condition as the height- 
ened influx of stimuli from a trauma. There are negative symptoms, consisting 
of general inhibitions of ego functions— in this case traceable to a decrease in 
available energy because of the energy consumed in the defensive struggle— and 
positive symptoms, consisting of painful feelings of tension, of emergency dis- 
charges representing attempts to get rid of the tension and including emotional 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT 169 

spells of anxiety and rage, and producing sleep disturbances due to the impossi- 
bility of relaxation (cf. 41). 


SPECIFIC AVOIDANCES AND INHIBITIONS 

Persons with specific countercathexes frequently avoid certain situations or 
objects or activities or fields of interest or qualities of feeling, sometimes without 
being aware of the avoidance, sometimes with full consciousness of it. Or instead 
of a full avoidance, there may be a decrease in functions or a specific lack of 
interest. 

Sometimes such persons feel consciously that they just “hate” the fields in 
which they are inhibited; sometimes they feel afraid of them or embarrassed if 
they have to face them; sometimes they assume that they have no objection to 
these fields but are merely “not interested” in them; sometimes they are not 
aware of the existence of any avoidances, but there are objective hiatuses in their 
mental continuity and analysis has to expose them and to make the persons face 
their antipathies; sometimes they may like to engage in the “inhibited” activities 
but experience the inhibition as an ego-dystonic disturbance occurring against 
their will. An intense dislike of formal parties, a shyness at such affairs, a lack 
of interest in or understanding of music, a feeling of fatigue and lack of power 
on occasions where others would feel rage, and a psychogenic sexual impotence 
are illustrations of these possibilities. It is not clear what determines the type of 
inhibition that is developed. It depends partly upon the person’s constitution and 
history and partly on actual libido-economic circumstances. 

Analysis always shows that the specifically avoided situations or the inhibited 
functions have unconsciously an instinctual (sexual or aggressive) significance. 
It is this instinctual significance against which the defense really is directed. 
What is avoided is an allusion either to a temptation for the warded-off drive 
or to a feared punishment or both. 

IMPOTENCE AND FRIGIDITY' 

The instinctual significance of inhibited functions is, of course, manifest where 
the inhibition concerns sexuality. Sexual inhibitions constitute the most frequent 
symptoms occurring in every type of neurosis, and range from slight shyness in 
approaching the opposite sex to complete impotence or frigidity. The inhibition 
may be felt as an antipathy to sexual activities or as a lack of interest in them; 
it may be effective without any awareness by the individual (e.g., the individual 
may feel that it is mere chance that he has not found any partner, whereas ac- 
tually he or she has actively prevented the possibility of finding a partner) ; or 
it may manifest itself as impotence or frigidity occurring when the individual 



^70 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

consciously is longing for satisfaction. The inhibition may cover the whole field 
of sexuality or only certain aspects of it— for example, only sensuality or only 
tenderness or only the experience of orgasm or only certain types of partners or 
only certain accompanying features associatively connected with infantile ex- 
periences that aroused sexual fears. The inhibitions may be effective whenever 
the conditions arousing the infantile fears are present or only under certain spe- 
cial circumstances as, for example, in the absence of some specific reassurance. 

It may happen that precisely the manifest inhibition offers an opportunity 
for some unconscious drive to find a distorted outlet. Persons who are uncon- 
sciously'afraid of injuring their sexual partners may actually hurt them by their 
inhibited behavior; a feminine-receptive or masochistic attitude may find ex- 
pression in a man’s impotence, a sadistic one in a woman’s frigidity. However, 
this is incidental. Essentially, impotence and frigidity are not reitirns of the 
repressed from the repression but clinical manifestations and bulwarks of the 
defense itself. Unconsciously the person believes that sexual activity is dangerous, 
and the defensive force that therefore demands avoidance of the sexual act is 
sustained and assured by physical interference with the physical reflexes. Impo- 
tence is a physical alteration arising from a defensive action by the ego which 
prevents the carrying out of an instinctual activity regarded as dangerous. The 
part of the ego that exerts this action certainly is an unconscious one; it is the 
part in which castration anxiety is operative and which has at its disposal path- 
ways that are not subject to voluntary control (448, 1474). 

The ego renounces sexual pleasure if this pleasure is believed to be connected 
, with an intense danger. As a rule, the basic danger implied is castration, the un- 
conscious idea being that the penis might be injured while in the vagina. Fear 
over loss of love plays a smaller part as a cause of impotence. Fear of one’s own 
excitation, however, may complicate the castration anxiety. The reason these 
dangers are believed to be connected with sexual intercourse is obvious: the 
fear was once connected with infantile sexual aims; these infantile sexual aims 
, were warded off and have thus been preserved in the unconscious; they come 
up again whenever sexual excitement is experienced. Since the preservation of 
infantile sexual aims is one of the characteristic traits of neurosis, disturbances 
of potency are found as accompanying manifestations of all neuroses. 

The nuclear complex of infantile sexuality is the Oedipus complex. In the sim- 
plest and most typical cases, impotence is based on a persistence of an uncon- 
scious sensual attachment to the mother. Superficially no sexual attachment is 
; completely attractive because the partner is never the mother; in a deeper layer, 

! every sexual attachment has to be inhibited, because every partner represents 
‘ the mother (555). 

' But this is not necessarily true of all cases. There is the “complete Oedipus 
Icomplcx” (608). The man with an unconscious feminine orientation may likc' 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT ^ 7 ^ 

wise avoid exercising his sexual functions because of anxiety, and “feminine 
identification” plays an important part in the psychogenesis of more stubborn 
cases of impotence (1475), That does not mean that “homosexuality represses 
heterosexuality” but rather that the same factors which made the man homo- 
sexual make him impotent toward women. 

Undoubtedly the rejection of all other feared infantile sexual aims, that is, of 
pregenital fantasies, may also determine an impotence (in). 

There are all degrees of impotence as well as innumerable variations of fre- 
quency. Many men are not constantly impotent, but experience only occasional 
failures or even only weakness of erection. Such relative impotence affords a 
special opportunity for analyzing the unconscious fears involved by analyzing 
the occasions on which the disturbance occurs. It invariably turns out that such 
occasions tend either to mobilize special infantile strivings or to increase special 
infantile anxieties. 

Many men are impotent toward one woman or toward one type of woman 
and not toward others. Frequently, such men isolate sensuality from tenderness 
and are impotent toward women they love (572). Many men have subjective 
conditions of love, that is, conditions instrumental in soothing unconscious anxie- 
ties which oppose the sexual pleasure. These conditions may dictate, for exam- 
ple, the partner’s body type or the behavior expected of the partner; the degree 
of the conditions may vary from being mere preferences to absolute necessities 
without which complete impotence occurs. 

The following case gives a typical example of conditions for potency with the 
significance of reassurance against infantile fears: 

A patient experienced his first sexual failure when he and his partner lay in bed 
covered by a blanket. He immediately blamed the blanket; and actually, later on, 
he was always potent when lying uncovered, impotent when covered by a blanket. 
This was a kind of claustrophobia. The patient had a sense of security as l(;^g as 
he had the feeling of being in control, apd he had this feeling as long as he was 
able actually to see what was going on. Analysis brought out that as a boy he used 
to masturbate only when covered by a blanket because this condition was a guar- 
antee of not 'being seen. Thus his present condition of potency could be translated: 
“What I am doing here is not masturbation, is not what I did as a child, and what 
I am still unconsciously afraid of.” 

Of course, it may be added, this patient’s sexuality was a mere narcissistic need 
to prove his potency. His intention was to show off: “You see how free I am!” He 
had many girl friends, but no deep or tender relationship with any of them. On 
a deeper level the idea of not being covered during intercourse meant having a 
way open for escape. 

Paradoxically, sometimes conditions for potency seem to be less a reassurance 
against what had been feared in childhood than a stressing of the very facts that 
had once been frightening. The underlying idea is that potency is possible only 



^72 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

if the man proves to himself that he can now face that which he once feared 
(cQunterphobic attitude) (435). 

The form of impotence known as ejaciilatio praecox represents a more severe 
disturbance than the inability to get an erection. In ejaculatio praecox the in- 
tensity and frequency of the symptom likewise vary greatly. A relatively short 
duration of the act may signify only a mild form of disturbance, whereas a 
chronic ejaculatio ante portas is a severe disorder. In typical cases, Abraham 
found three frequent and mutually supplementary determinants (14): (i) A 
leading feminine orientation, as in cases of severe disturbances of erection. This 
orientation is noticeable in the nature of the leading erogenous zone: the climax 
of excitement is felt at the root of the penis and the perineum (or, more precisely, 
at the “feminine” zone in the prostatic tract of the urethra) rather than at the 
glans and the shaft of the penis. This condition may indicate a constituiionally 
enhanced bisexualiy; but it may also arise as a reaction to a psychogenic inhibi- 
tion of active phallic sexuality.. (2) A sadistic orientation, which is concealed 
under ostensible passivity, and which has as its aim to soil and to injure the 
woman (the mother). This sadism is typically pregenital, its execution a ure- 
thral-anal one; actually the passive prostatic sexuality of men never can be iso- 
lated from urethral and anal trends. We shall see later that cases of chronic 
neurasthenia are characterized by attempts to use the genital apparatus for pre- 
genital aims {see p. 191); actually ejaculatio praecox is a frequent symptom in 
cases of this kind. (3) An intensified urethral eroticism which makes the individ- 
,ual unconsciously regard semen in the same way he regarded urine as' a child. 
Also characteristic for cases of chronic ejaculatio praecox are strong feelings of 
guilt about masturbation, corresponding to the pregcnital and sadistic aims of this 
masturbation. In the symptom, the patients try to inhibit the expression of these 
objectionable aims, which nevertheless find a distorted expression (1530). 

Severe cases of ejaculatio praecox may also be rooted in conflicts of an oral- 
erotic nature. The patient may unconsciously be identified with a nursing mother; 
his original conflicts around being fed may have turned into conflicts around 
feeding, which find a distorted expression in the disturbance of ejaculation. 

Certain mild forms of ejaculatio praecox are more related to hysteria, and the 
disturbance occurs only occasionally. The ejaculatio in these mild cases is not in 
the form of a flow but in the form of spasmodic spurts, and there are other signs 
that the genital development was completed. This genital form of ejaculatio 
praecox shows a displacement of the prohibition of masturbation onto the pro- 
hibition of touching, the symptom expressing the idea: “The penis should not 
be touched.” In these genital cases the prognosis is much more favorable than in 
the pregenital cases related to chronic neurasthenia (1267, 1268). 

The disturbance of ejaculatio retardata has, as a rule, more of the character of 
a true conversion symptom. It may express unconscious fears about dangers 



DIRECT CLINICAL SYMPTOMS OF TEIE NEUROTIC CONFLICT 173 

supposed to be connected with the ejaculation (castration, death), or strivings, 
anal (retaining) or oral (denial of giving [io8, no]) sadistic or masochistic in 
character. 

Much has been written about female frigidity. Satisfactions that may be hid- 
den in the symptom have been described, the role played by clitoris sexuality 
has been stressed, even anatomical causes for frigidity have been sought (171). 
But in general there is no doubt that frigidity is the expression of an inhibition 
of a complete sexual experience, rooted in anxiety about a danger which uncon- 
sciously is associated with the full attainment of the sexual aim— a condition 
completely analogous to male impotence (322, 796). The general cause for the 
frequency of cases exhibiting various degrees of frigidity is unquestionably as- 
cribable to the education of girls which succeeds in creating the association be- 
tween “sexuality” and “danger.” 

Here, too, it appears that the gratification of a persisting infantile sexual aim 
is perceived as a danger to be avoided, either as a danger of being injured or as 
a danger of losing love, both fears being frequently perceived as a fear of one’s 
own excitement. As in impotence, the degree of severity of the disturbance varies 
greatly. There are women who occasionally fail to achieve a full vaginal orgasm, 
and those who never achieve such an orgasm but who do experience excitement 
and may achieve an orgasm at the clitoris. There are women who can be aroused 
but who never achieve any climax, and others who occasionally cannot be 
aroused at all. Finally, there are cases of total frigidity, whose genital erogeneity 
is entirely blocked. In these cases “‘not to feel anything” expresses the idea: ‘T 
do not want to have anything to do with it,” which is a special case of the gen- 
eral type of defense of estranging oneself from one’s own body. This estrange- 
ment is the same as in the sensory disturbances of hysteria {see p. 227). 

The “dangerous” infantile sexual aims, which are co;nnected with sexuality 
in cases of frigidity, vary more than the unconscious infantile sexual aims in im- 
potent men, due to the fact that the sexual development of girls is more compli- 
cated than that of boys. Primary in significance, of course, is again the Oedipus 
complex; unconscious comparisons of the sexual partner with the father may dis- 
turb sexual enjoyment, just as thoughts of the mother may cause impotence in 
men. Then there is also the “masculine identification.” However, masculine iden- 
tification in women and feminine identification in men are not simply analo- 
gous. The facts of penis envy and of the long preoedipal attachment to the 
mother offer more opportunities for the development of fixations and disturb- 
ances. Since the aims of the preoedipal mother fixation are mostly pregenital 
ones, we see fears concerning pregenital aims very frequently as causes of frigid- 
ity (626, 628 ) . Fear of losing control seems to be in the foreground. Very often 
one finds that the terrible thing that may happen when control is lost at the 
climax of excitement is unconsciously thought of as a loss of control of the 



174 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


sphincters and especially, in women with a penis envy and a heightened urethral 
eroticism, as involuntary wetting (421). 

Masculine identification is connected with another point o£ great importance 
in frigidity. Many frigid women are frigid vaginally only; the clitoris has pre- 
served its normal or more than normal excitability. Since the clitoris is the pri- 
mary erogenous zone in feminine infantile genitality, such frigidity can be con- 
sidered a form of arrested development. The refusal of the clitoris to turn over 
its primacy to the vaginal zone may be due to an anxiety related to the vaginal 
zone (which probably ijs the decisive factor) ; or it may be due to a special height- 
ening of clitoris erogeneity, which may either be constitutional or be acquired 
during the phallic period. The actual state of affairs is further complicated by the 
aforementioned fact that clitoris masturbation, which is responsible for the ex- 
citability of the clitoris becoming fixated, serves as an outlet not only for auto- 
erotic and masculine fantasies but also for definitely feminine sexual fantasies. 

Like impotence, frigidity may secondarily give opportunity for a distorted 
expression of unconscious drives — of masochistic strivings or even of active sa 
distic impulses (“revenge on the man”), but certainly neither masochism nor 
hatred alone could determine frigidity; only the anxiety about what would hap- 
pen if a striving for suffering or hatred were yielded to can be decisive. However, 
what has been warded off may return and penetrate the defensive measures. 

Vaginismus is related to frigidity as reaction formation is to repression; not 
only is the sexual excitement inhibited, but something positive is done to ensure 
the maintenance of such an inhibition and to make intercourse physically im- 
possible. The typical cases of vaginismus develop spasms which make the in- 
sertion of the penis impossible. Cases of penis captims are the subject of many 
anecdotes but are rarely described in scientific literature. The anecdotes are 
probably based more on male castration fears and female active castration tend- 
encies than on real occurrences. Vaginismus frequently is no pure inhibition but 
rather a positive conversion symptom; it then not only expresses the tendency 
to offer an obstacle to sexuality but also a distorted unconscious wish. This wish 
may be the idea to break off the penis and to keep it; in other words, vaginismus 
may be an expression of the revenge type of the female castration complex (20), 
or a spasm of the floor of the pelvis may be an expression of an anal conception 
of penis envy: the idea of pressing out and/or of retaining an anal penis (1136). 

Whereas a man’s impotence is obvious, a woman’s frigidity can be hidden. 
Many women who feel their frigidity not as a virtue but as a being crippled lie 
about their condition. Various secondary complications and neurotic reaction 
patterns may develop out of such a denial of the symptom. Loss of erection in 
men cannot be hidden. There are, however, various ways in which a relative 
impotence may be disguised so that analogous secondary complications may 
occur in men, too. The most frequent complication of this type is an attempt to 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT ^75 


overcompensate the sexual inhibition. Women as well as men may behave espe- 
cially “oversexed,” to cover up an original inhibition. The narcissistic need to 
prove that one is not impotent or frigid is a frequent cause of pseudosexual be- 
havior, that is, for sexual behavior which preponderantly is not produced directly 
out of a sexual need but out of a narcissistic need {see pp. 515 ff.) , 

Inhibitions of sexual intercourse are not necessarily the only genital inhibi- 
tions. Other genital functions, too, may be inhibited if they represent objection- 
able drives. A psychogenic resistance to pregnancy certainly can influence the 
course of pregnancy and childbirth in an unfortunate way, probably chiefly by 
influencing the muscular functions but also to some extent the circulatory and 
metabolic ones (27, 322, 359, 816, 902, 1128, 1139^2, 1306). Whether there is a psy- 
chogenic inhibition of procreation, that is, a psychogenic sterility, is not certain. 
Some authors believe it, and cases in which women after years of sterility have 
become pregnant immediately after their decision to adopt a child (1210) in- 
crease such a suspicion. 


INHIBITIONS OF PARTIAL INSTINCTS 

Other specific inhibitions occur not directly in the sexual sphere but in those 
functions which in childhood had a sexual significance. In impotence and frigid- 
ity, the fears and guilt feelings that create the defense, and thus the inhibition, 
were so closely connected with the sensations of sexual excitement that they 
became shifted from infantile sexual functions to adult ones when the excitement 
was shifted in the same direction. In inhibitions that correspond to the repression 
of a particular component impulse, the infantile functions themselves remain 
inhibited (618). 

If oral impulses have been subjected to specific repressions, a frequent result is 
in an inhibition of eating, or of eating certain kinds of food which are uncon- 
sciously reminiscent of the objects desired by the repressed oral-erotic strivings. 
Again, the inhibitions extend from hatred of such food or general lack of interest 
or enjoyment in food, to hysterical vomiting or spasms of the jaws (384, 1106, 
1574). The oral inhibitions may be displaced onto other activities with a hidden 
oral significance, such as drinking and smoking, social activities, or reading ! 
(1512). 

It is true that children who refuse to eat may do so to express some negative 
feelings toward their parents (or parental surrogates) . However, the more such 
protests are concentrated on eating alone, the more probable it is that the basis 
of the protests is a specific oral conflict, and that the defense is not only directed 
against frustrating objects but against oral drives as well. Such defense is espe- 
cially marked if the oral drives, after having been frustrated, have acquired a 
sadistic character. 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 

Orality, as the oldest field of instinctual conflicts, can be used later on to express 
any other instinctual conflicts, especially if experiences in infancy have left an 
oral fixation that facilitates a displacement from subsequent frustrations (primal 
scenes, birth of siblings) to oral conflicts. Any conflict between activity and 
receptivity may result in eating disturbances. Since parents who have had dif- 
ficulties in helping their children to make an adequate adjustment on an oral 
level usually have difficulties again in training their children for cleanliness, and 
since, among the anal frustrations, the prohibition of taking feces into the mouth 
is especially stressed, it is understandable that anal conflicts, too, may be expressed 
by children through oral inhibitions, through inhibitions in eating (1489), as well 
as through inhibitions in speech (291, 292, 708) {see pp. 31 1 ff.). If a refusal to eat 
has an especially stubborn character, expressing primarily the attitude “I will not 
let myself be controlled; I eat when and what I like,” then anal components are 
mainly involved. 

In the genital sphere, eating usually has the unconscious significance of “be- 
coming pregnant,” and this equafion, too, may cause various inhibitions in eat- 
ing. Since a high percentage of all oral pregnancy theories arc based on the belief 
that the woman cats the man’s penis, revenge types of feminine castration com- 
plexes (20), if inhibited, may also result in eating inhibitions. 

Specifically disliked kinds of food unconsciously symbolize milk, breast, 
penis, or feces (126). However, a refusal of food docs not necessarily rep- 
resent a repression of eating cravings. A specific food may be rejected ob- 
stinately because it is not the desired one: “I do not want this food but that”; 
or “I do not want food but love (or a penis, or a child).” In this instance, it is 
not a drive that is refused but the acceptance of a substitute (24), 

Specific eating taboos may secondarily become rationalized or idealized {see 
pp. 485 f.). It is cruel to eat animals, or dirty or unhygienic to eat this or that. Ra- 
tionalizations of this kind are-often suggested by modern food theories which 
tend to prohibit naive sexual pleasure in food and to connect eating with the 
superego sphere. You are not supposed to eat what is good but rather “what is 
good for you” (mi). 

If an eating taboo in later life is neither rationalized nor fixated in ego- 
dystonic conversions like vomiting or spasms of the jaws but becomes the core 
of a more or less ego-syntonic pathological behavior, this is called anorexia 
nervosa. Anorexia regularly can be traced back to eating disturbances in child- 
hood which under certain libido-economic circumstances are subsequently taken 
up again (1324). Like the disturbances in childhood, later anorexias, too, may 
have a very different dynamic significance. It may be a simple hysterical symptom 
, expressing the fear of an orally perceived pregnancy or of unconscious sadistic 
■ wishes. It may be a part of an ascetic reaction formation in a compulsion 
neurosis. It may be an affect equivalent in a depression, in which the symptom of 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT ^77 


refusal of food makes its appearance before other signs of the depression are 
developed. It may be a sign of the refusal of any contact with the objective world 
in an incipient schizophrenia. 

However, two other types are chiefly thought of first if anorexia is mentioned. 
The one is an organ neurosis in which an interrelation of oral mental conflicts 
and hormonal metabolism is operative, the one influencing the other, resulting 
in a total loss of appetite and in loss of weight (1121, 1555) {see p. 260). The 
other type is a severe psychogenic developmental disturbance of the ego in 
which the anorexia in an orally fixated person is only one symptom of a general 
disturbance of all object relationships. 

A patient of Eissler’s (361) had not gone beyond an extremely archaic stage of 
ego development. The mother “remained the most important part of the patient^s 
ego.” The refusal of food represented the longing for the primary, still undif- 
ferentiated gratification by the mother and its sadistic distortion after frustration. 
The mother’s total lack of tenderness and physical affection had created a severe 
disturbance in the patient’s construction of her body image. A case of Lorand’s 
was disturbed in a similar way (1082). 

Since a repression may manifest itself either by an inhibition or by an exaggera- 
tion of a compensating opposite, the antithetic states of “anorexia” and “patho- 
logical craving for food” (bulimia) are related to each other, at least in the same 
sense as melancholia and mania are related to each other. As a rule, infantile eat- 
ing inhibitions are found in the childhood history of subsequent food addicts 
(see p. 381). 

Repressions of anal eroticism create specific anal inhibitions, either inhibitions 
in the physical functions like constipation (which simultaneously may bring a 
distorted discharge to anal-erotic strivings for retention) or an anal prudishness 
or a reactive cleanliness. Again, inhibitions of this kind may be combined with , 
a substitutive obsessive interest in anal matters on some other level (21, 883, 

1143)- 

How specific repressions of exhibitionism may create specific social inhibitions 
which occasionally are decisive for the individuaFs later life has been popularized 
by Moss Hart’s Lady in the Dar\ (745). 

If^Sj^optophilia has been repressed, inhibitions of looking come to the fore 
(571). In extreme cases they may develop to such an extent that the person 
actually becomes unable to look at things and instead lives in abstractions only. 
In less extreme cases, the patient may turn away from seeing a special class of 
objects, for example, of things that remind him of facts that once aroused castra- 
tion anxiety (8). Often frightening sights result directly in subsequent inhibi- 
tions of looking, and frightening sounds in subsequent inhibitions .pf hearing. 

Fright, as is well known, paralyzes. Inhibitions in the realm of motility may 
mean “I am frightened”; very often they mean “I am paralyzed by a frightening 
sight, that is, by a sight that makes one face the possibility of castration or death. 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


178 

Myths and fairy tales, dreams and neurotic symptoms portray petrification as 
the specific punishment for scoptophilic interests (296, 500) . “Stone” means “im- 
mobility,” and this punishment signifies the body feeling of motor inhibitions 
arising from fright. It may simultaneously be an anticipation of death or castra- 
tion (430). 

INHIBITIONS OF AGGRESSIVENESS 

Whether aggressiveness is looked upon as a separate class of instinctual de- 
mands or as a way in which frustrated or pregenitally fixated persons try to 
approach their instinctual aims, there is no doubt that in either case there are 
various and frequent specific inhibitions of aggressiveness due to anxieties and 
guilt feelings in persons whose aggressive or sadistic (and masochistic) tenden- 
cies have been repressed. In this class belong the reactive kindness and polite- 
ness typical for compulsion neurotics. Frequently these persons avoid all argu- 
ments and react with “breakdowns” when certain conditions cease to be effective, 
which unconsciously mean reassurance that everything is peaceful. Many per- 
sons develop sexual inhibitions because for them sexual excitement and rage 
have become too closely interwoven. Such is the case when tlie frustrations of 
infantile sexuality have led to an intense longing for destructive revenge, the 
intrusion of which into any excitement is now rightly feared. Many an “occupa- 
tional inhibition” turns out to be actually an inhibition of aggressiveness, since 
under our cultural conditions, aggressiveness is necessary for a healthy career. 
Characters of this type literally or emotionally withdraw from the world because 
for them it is a world filled with murder which they might either have to deal 
out or suffer. The passivity created in this manner in its turn may either become 
sexualized (passive homosexuality or oral receptivity being increased to hold a 
feared aggressiveness in check) or it may be overcompensated by a layer of 
cramped and false counterphobic aggressiveness. 

An emotionally very cold patient, who monotonously discussed apparently indif- 
ferent matters for many analytic months, considered all aggression “unintel- 
ligent,” neglected his technical profession because, as he said, all technical inven- 
tions are misused for warfare and he was not willing to further this purpose; he 
would, -nevertheless, not associate for two minutes without subjecting conventional 
institutions or the behavior of other persons to intense criticism. Indeed, mtel- 
lectual critique was the sole matter of his associations. In this manner, his warded- 
off impulses “forced themselves out through all pores,” to use Freud’s expression 

(553)* 

Another, emotionally paralyzed patient, who usually turned all his aggressions 
against himself and could not harm a fly, aggravated his symptoms to the extent of 
yielding completely to every compulsion, even to the mildest. In self-justification 
he said: “I want to find out if the analyst can remove my symptoms if I do not 
want him to.” Thu^ he distorted the analytic situation into a battle, the very thing 
he was supposedly trying to avoid. 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT ^79 

Persons with a repressed intense hatred may perceive any activity as aggression; 
thus severe cases block all activity (469). “Specific inhibitions of aggressiveness,” 
then/ lose their specificity and turn rather into the generally inhibited types. 

The contents of unconscious fears, too, may lead to definite inhibitions: a per- 
son governed by fear over loss of love will have to avoid anything that increases 
the danger of not being loved, and thus will develop definite social inhibitions 
corresponding to his social dependency. A person who is afraid of his own excite- 
ment will block all activities that might increase his excitement. And, last but 
not least, a man with a castration anxiety will develop specific inhibitions cor- 
responding to the specific form of his castration anxiety. An individual, for 
example, who as a child was frightened by a tailor’s scissors may become in- 
hibited from going to the tailor’s, and eventually become negligent in appearance. 

INHIBITIONS OF SEXUALIZED FUNCTIONS 

The same inhibitions that were applied to sexual functions in the cases dis- 
cussed until now may also be applied to any function that has been sexualized 
through a previous displacement. In reference to this process, Freud stated: “We 
have gained insight into this situation, and understand that the ego function 
of an organ becomes affected whenever the crogeneity, that is, the sexual sig- 
nificance of this organ, increases. If I may be allowed a somewhat scurrilous com- 
parison, I should say that the organ behaves like a cook who no longer wants to 
work in the kitchen because she and the master of the house are having a love 
affair. When the act of writing, which consists in letting a liquid out of a tube 
onto a piece of paper, acquires the significance of coitus, and when walking 
becomes the symbolic substitute of stamping on the body of Mother Earth, then 
both writing and walking have to be discontinued because it is as if the per- 
formance of these actions meant the carrying-out of the forbidden sexual acts. 
The ego thus gives up the functions in order to avoid the necessity of under- 
taking new repressions” (618), 

On closer study, one sees that there actually is a dual origin to inhibitions of 
this type; practically, however, it is difficult to distinguish between them. The 
sexualization of a function leads to an inhibition, either because the ego is striv- 
ing for or because it is blocking the sexualized pleasure. In some instances it may 
be very important to know whether the ego is functioning poorly because it is 
seeking sexual gratification, instead of performing its nonsexual task, or because 
it discontinues the sexualized function out of anxiety. 

All tht ego functions presuppose an overcoming of the phase of the pleasure 
principle in which they were used in the service of direct pleasure seeking. Thus a 
“sexualization” of an ego function is also a failure in “desexualization.” Muller- 
Braunschweig developed the theory that the process in the young child of dis- 
covering his own organs and their functions is a process that closely resembles 



i8o xhe psychoanalytic theory of neurosis 

identification (1162, 1163). By mastering an excitation, the mastered function be- 
comes a part of the ego and is thereby dcsexualizcd. Thus the ego functit)n of the 
organ is established; any regression toward its autocrotic use impairs the function. 
The artist has sublimated his impulse to smear through a kind of identification 
with smearing activities; the pseudo artist who still (or again) seeks direct sexual 
pleasure in smearing impairs his ability. 

Disturbances of functions that served the purpose of suppression of sexuality 
may gradually turn into hidden substitute gratifications; however, such cases 
are not to be considered as pure inhibited states any more but rather as conver- 
sions. 

Just as any organ may serve as an erogenous zone, so may any function be- 
come the victim of an inhibition. It is impossible, therefore, to enumerate all 
possible types of inhibitions. A few types which arc of clinical importance will 
be discussed. 

Mention should be made, first of all, of social inhibitions consisting of a gen- 
eral shyness which may manifest itself in a fear of blushing or in the conversion 
symptom of blushing (crythrophobia). Severe cases may be inhibited to such 
an extent that they withdraw from any social contact; they anticipate possible 
criticisms to a degree that makes them hardly distinguishable from persons 
with paranoid trends. Less severe cases are unconsciously governed by the fear 
that (and the desire that) their masturbation may be found out or by sexual 
(scoptophilic) aggressive strivings (118, 356, 405) {sac pp. 518 fl.). 

Deserving special emphasis are certain body inhibitions both in the motor and 
sensoi*y spheres. Motor inhibitions include not only such gross signs as hysterical 
abasia or physical clumsiness but also the more delicate awkwardnesses and pur- 
poseless motor actions and even the many local muscular spasms and rigidities 
of normal and neurotic persons. However, motor inhibitions are not necessarily 
manifested by hypertonic phenomena but may also appear as a limp and hypo- 
tonic muscular slackness which excludes the possibility of speedy and precise 
functioning {see p. 247). Among the sensory inhibitory disturbances are the 
sensations of physical estrangement and the whole field of inhibitions in respect 
to internal perceptions which are usually intimately associated with motor 
dysfunctions; the sensory inhibition (insufficient awareness of one’s own body) 
causes secondary motor disturbances (410). 

In addition to physical inhibitions, there are mental ones. Quite a percentage of 
so-called feeble-mindedness turns out to be pseudo debility, conditioned by in- 
hibition (103, 173, 393, 842, 957, 1019, 1020, 1099, 1192, 1403). The existence of the 
mechanism of intellectual inhibition can be studied in every analytic hour 
marked by resistance. Every intellect begins to show weakness when affective 
motives are working against it. Analysts talk jokingly of “slight dementia 
by resistance.” 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT 

People become stupid ad hoc, that is, when they do not want to understand, 
where understanding would cause (castration) anxiety or guilt feeling, or would 
endanger an existing neurotic equilibrium. Actually, psychoanalytic interpreta- 
tions are nothing but attempts to give the patient insight or to show him connec- 
tions when emotional resistances hinder his spontaneous understanding. 

There are two main reasons why an ego may be induced to keep its intellect 
permanently in abeyance. 

1. A repression of sexual curiosity may block the normal interest in knowing 
and thinking (561). Often the inhibited sexual curiosity corresponds to an in- 
tense unconscious scoptophilia (103) or stands in intimate relationship to sadistic 
impulses (1097, 1397); the consequent “stupidity” may represent simultaneously 
an obedience to and a rebellion against the parents from whom the patient had 
suffered frustrations of his curiosity (174, 519). Understanding the genetic rela- 
tionship between the impulse to know and oral pleasure or, later, manual grasp- 
ing pleasure and still later anal mastery (249, 461, 1059, 1405) makes it easier to 
understand why oral, manual, and -anal repressions play such an important 
role in intellectual inhibitions, the latter appearing as “mental obstipation” (393, 
1403). The stupidity that manifestly expresses the inhibition of curiosity 
may unconsciously be -used in various ways to satisfy this very curiosity by 
gaining access to scenes that would be kept secret from a. “less stupid” child 
(1099). 

2. Exactly as in other inhibitions, the inhibited intellectual functions may have 
been sexualized in a much stricter sense. Actually, the function of thinking may 
be equated with the sexual functions in both men and women; its inhibition, 
then, has the meaning of castration (or of the avoidance of castration) (1192). 
The sexualization of the function of thinking always has special anal connota- 
tions {see pp, 299 f.). 

Studies have been made of a number of specific disturbances of intelligence, 
such as the failure of children in certain subjects at school, or their inability or 
unwillingness to study certain things. The analytic study of such cases corrob- 
orates what has been said about inhibitions in general. The particular subject, 
or something associated with the first instruction in this subject, or the personality 
of the teacher and his way of teaching, or an accidental feature that essentially 
had nothing to do with the subject proper, like a particular number in mathe- 
matics or a particular letter in reading or writing, proved to be associated with 
fundamental conflicts around infantile sexuality (909, 1067, 1068, 1227, 1234, 1257, 
1360, 1528, 1543, 1639, 1641, 1644, 1645, et al). 

Closely connected with the inhibition of thinking are the inhibitions of speech, 
ranging from hysterical mutism and stuttering to insecurity in the manner of 
expression or in the choice of words. Occasionally speech difficulties appear only 
in certain situations or in the presence of certam persons, situations or persons 



i 82 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


promoting the mobilization o£ old unconscious conflicts* Since thinking is in- 
timately connected with speech, the conditions producing speech difficulties are 
quite similar to those producing inhibitions of thinking {see pp. 311 ff,). 

Mental inhibitions are not limited to the sphere of intellect. There are also 
inhibitions in the spheres of emotions and will. Like psychogenically stupid 
persons, there are also persons who are psychogenically cold and ajflectless or 
indecisive and weak. Because their emotions are connected with instinctual 
conflicts, such persons inhibit their emotional life to avoid the conflicts; 
or they displace unconscious conflicts and therefore feel contradictory about 
any utterance of their will. They may overcompensate for emotional im- 
maturity by an intense development of their intellectual life. There is also a real 
repression of the affective life, a sort of shutting out of all direct and warm rela- 
tionships with persons and things, a general frigidity, so to speak. Such attempts 
to block all feelings may or may not be successful. Sometimes in such persons, 
explosive emotional outbreaks occur under certain exceptional circumstances or 
in dreams {see pp. 417 ff.). The alienation of one’s own feelings, characteristic for 
compulsion neurotics, generally is a result of a long development. Sometimes, 
however, a general frigidity may originate in one specific traumatic scene so 
fraught with emotion that from then on the subject becomes afraid of emotions 
altogether. The phenomena of depersonalization, too, are to some extent related 
to these reactions; they are inhibitions of particular feelings or other internal 
perceptions, the countercathexis appearing as heightened self-observation {see 
PP.418E). 

Inhibitions in the sphere of will are operative within persons who avoid inde- 
pendent decisions of any kind. This disturbance may be part of an obsessive 
tendency to doubt everything and to prepare for ‘action instead of to act, which 
in severe cases may lead to a disastrous “paralysis of will” (109, 567). Or the 
disturbance may be due to a defect in the functions of the superego; the capacity 
of will is renounced and the making of decisions is left to others because of fear 
of aggression or of need for external approval (803) {see p. 520). Various kinds 
of conflicts with objects may also find expression in a neurotic indecisiveness 

(115). 

It is very probable that a certain proportion of “lack of talent” is not due to an 
actual absence of ability (772), but to a special psychogenic inhibition. This 
seems to be true of a great many so-called unmusical people. In the course of 
analysis, a number of such individuals come to admit that music is not actually a 
matter of indifference to them, but that it is unpleasant. This feeling of unpleas- 
antness then turns out to be connected with their repressed infantile sexuality 
(125, 845). The same point of view applies to persons with inhibitions in regard 
to painting, and even to some cases of color blindness and tone deafness (1505). 

Other specific inhibitions have a still more complicated origin than the exam- 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT ^^3 

pies hitherto discussed. Certain persons with a particularly intense sense of guilt 
dating back to their infantile sexual conflicts labor under the constant necessity 
of paying off a debt to their conscience (618). The extreme representatives of this 
type are the personalities described by Freud under the headings “those wrecked 
by success” (592), the “criminal from a sense of guilt” (592), and the “moral 
masochists” (613). These individuals seem to feel that they must not utilize the 
talents or the advantages that are theirs by natural endowment and character; 
they inhibit those of their functions that might lead to success.. Their inhibitions 
gratify the demands made by the superego on the ego. 

Freud has repeatedly called attention to the fact that one of the most difficult 
tasks in psychoanalysis is that of conquering a severe unconscious sense of giiilt 
(613, 629). There are, however, cases more amenable to treatment where the 
patient does not bow so completely to his superego that he fills his whole life 
with ruinous inhibitions, but instead inhibits one or two specific functions. To 
this group belong a considerable number of the so-called occupational neuroses, 
like writer’s cramp or violinist’s cramp (352, 867) . 

“Occupational inhibition” is not, of course, psychologically a unit. It occurs 
whenever a person’s occupation requires the performance of actions that have 
become inhibited. Thus all types of inhibitions may form the basis of occupa- 
tional inhibitions (952, 1318). However, four things are worth mentioning: 
(i) Work, under present-day conditions, is the way to independence and suc- 
cess. Thus all conflicts around dependence and independence (orality) and 
around ambition may present themselves in the form of inhibitions of working. 
This explains why occupational inhibitions often represent the superego type 
of inhibition. (2) Under present-day conditions children often become ac- 
quainted with the conception of work under the aspect of “duty,” demanded by 
authorities, as the opposite of “pleasure.” All conflicts around authorities, all 
struggles between rebellion and obedience, therefore, may be expressed in the 
attitudes toward work. (3) Modern ideologies make it possible for persons who 
try to repress any instinctual demands to 'do so by becoming relatively hard 
workers, robots so to speak, without any pleasure in work but compelled to do 
it uninterruptedly (“reactive type of work”) (see p. 472). If the repressed im- 
pulses then rebel, the rebellion necessarily takes the form of a disturbance in 
working ability. (4) Often the conception of “occupational inhibition” is con- 
nected with “neurotic disturbances of attention and concentration.” These dis- 
turbances are not specific but rather general symptoms of the state of being 
dammed up. ‘ 

In other cases the inhibited spheres are still more circumscribed. Certain situa- 
tions, like open streets or high places, are avoided because of their connection 
with instinctual conflicts. These phobias will be discussed in the chapter that 
follows. 



184 the psychoanalytic theory of neurosis 

Every forbidden instinctual drive, be it a sensual, hostile, or tender one, strives 
for expression in action in the establishment of a contact with objects. There- 
fore, any one of them may lead to a general inhibition of motor activity. Inhibi- 
tions of playing, which some children develop, represent an inhibition of sexual 
or hostile impulses that would have been expressed in the game. The rejection 
o£ certain entire fields of activity frequently turns out to be a generalized inhibi- 
tion of masturbation; social inhibitions sometimes can be traced back to sexual 
fantasies built up by the child about adult social intercourse; inhibitions of intel- 
lectual grasp may represent inhibitions of sexual perceptions, for example, of 
recognizing the difference between the sexes (174)* Some persons feel inhibited 
when they have to greet people or show any other social amenity. The root of 
this inhibition lies in unconscious ambivalence (594, 1290) . 

Everyone feels certain functions or situations as unpleasant in an irrational 
way, that is, has fields where he is slightly inhibited. Everyone, because of inhibi- 
tions, is deprived of one or another mode of experience that might normally be 
his. Many patients, upon completion of analysis, state that they have acquired a 
new sense of the fullness of life; this new feeling probably appears not only 
because they are relieved of the necessity of spending a great deal of energy on 
repressions and symptom formation but also because those experiential capacities 
that were inhibited have become accessible anew. However, the removal of an 
inhibition of this sort is by no means an easy task; the older and the more in- 
grained a given inhibition, the more diflBcult it is to remove. Psychoanalysis of 
children, in this respect, is in a better position than psychoanalysis of adults. It 
may succeed in preventing inhibitions from becoming deeply rooted in the per- 
sonality, and thus may act as a prophylactic agent. 

Some inhibitions fulfill their task; by avoiding or inhibiting the function in 
question, the remobilization of old feared conflicts is likewise avoided. Most in- 
^ hibitions, however, due to the fact that the repressed tends to return and to 
develop derivatives, become structurally quite intricate. Inhibitions may widen 
to neighboring fields as well as inaugurate a highly cathected “substitute” by 
displacement of their energy. The person then gives the impression of being 
somewhat exaggerated in one respect or another; and the analysis reveals that 
the exaggerated field is a substitute for something that is lacking. 

In still other cases, complicated secondary adaptations of the personality to the 
inhibition are inaugurated, denials and reaction formations against them as well 
as overcompensations of them (see Chapter Twenty). 

In summary, the relation between the conception of “inhibition” and the con- 
ceptions of “repression” or “pathogenic defense” may be stated as follows. The 
inhibited states are clinical symptoms of the effectiveness of repression or other 
pathogenic defenses. 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT ^^5 


ACTUAL NEUROSES, SYMPTOMS OF UNSPECIFIC INHIBITIONS 

Any defensive mechanism using a countercathexis necessarily creates a certain 
impoverishment of the personality. The patient must engage in unfruitful de- 
fense measures, and thus is impoverished in the rational activities of life. The 
results are manifold inhibitions of ego functions and a chronic fatigue, or at 
least a readiness to get tired. 

This chronic fatigue doubtlessly is physical in character and probably due to 
the fact that the muscular attitudes of persons undergoing mental stress are al- 
tered (1523). It is very interesting that physiological research has shown that the 
degree of fatigue is not in direct proportion to the degree of obvious muscular 
stress but is rather dependent on the mental state in which the muscular task was 
fulfilled. Persons in conflict tend to become tired more quickly than persons with a 
free mind. However, the problem remains as to how the conflicts create the chemi- 
cal alteration basic to fatigue ( increase of lactic acid in the muscles and lowering of 
blood sugar); probably they do so by changing the person’s muscular behavior. 

The awareness of this chronic impoverishment and fatigue constitutes a por- 
tion of the neurotic inferiority feelings (585). Energies that arc needed for the 
defensive struggles are deflected from other functions. 

The patients become generally disinterested and moody. Some of them feel 
simultaneously the paralyzing fatigue due to impoverishment and the tension 
and restlessness originating in the warded-ofi impulses that demand discharge. 
They feel the necessity for an outlet and nevertheless a lack of enthusiasm and 
interest in anything that might be used as an outlet. They want to be told what 
to do (because the real aims are unconscious) and they reject all suggestions 
(because they want no substitute) (422). ‘ 

Neurasthenic disturbances of the ability to concentrate, which form the main 
complaint of so many neurotics, arc of the same nature. The first reason 
such patients cannot concentrate on a conscious task lies in their unconscious 
preoccupation with a more important internal task, their defensive struggle. In 
severe cases, archaic and integrated activities replace the more recently acquired 
and differentiated ones; a resistance is developed against differentiated tasks and 
even against the acceptance of new stimuli, the reaction to which would need 
new amounts of energy. Another cause of the disturbance of concentration is the 
fatigue originating in the consumptive defensive struggle. Actual neurotics arc 
hypersensitive and irritable because their state of relative insuflSciency of ego 
control makes them react to slight stimuli as if they were intense ones. 

The feeling of being bored probably is generally, at least in its neurotic exag- 
geration, a state of excitement in which the aim is repressed; anything the person 
can think about doing is felt as not adequate to release the inner tension. Bored 



i86 the psychoanalytic theory of neurosis 

persons are looking for distraction, but usually they cannot be distracted because 
they are fixated to their unconscious aim (422). 

The inner tension expresses itself often as an external muscular rigidity; other 
persons are more hypotonic and lax; still others are characterized by alternations 
of hyper- and hypotonic states (410). The “irritable weakness of neurasthenia 
is an expression of this simultaneity of fatigue and tension. 

The general neurotic inhibition due to quantitative impoverishment is an 
accompanying feature of all types of neuroses. Any repression may manifest 
itself objectively as an inhibition. However, there are pathological states in which 
the general inhibition dominates the clinical picture, sometimes in an acute, 
sometimes in a chronic form. The acute form sets in when some actual situation 
demands an immediate and sharp defensive measure; it disappears when the 
task is fulfilled or the situation is changed. The chronic form appears as a life- 
long attempt to keep down some “dangerous” impulse, at the expense of the 
development of the total personality. Such persons seem to live less intensely 
than others; they are conspicuous for their apathy, indifference, and lack of 
initiative. In unconscious content, the chronic forms, as a rule, represent defenses 
against aggressive and sadistic impulses. 

Freud described a patient who would fall into a state of apathy under condi- 
tions which in a normal person would provoke an attack of rage (618). Analysis 
of chronically apathetic individuals reveals that they were originally extremely 
aggressive, but because of castration anxiety inhibited their aggression and some- 
times turned it against their own ego. 

A patient with a passive personality, the “model-boy” type, had been quite 
spoiled in the first years of his life, which he spent with his mother and grand- 
mother. He sustained sudden and severe frustrations at the hands of his father 
soon after they met for the first time. It was about that time that a brother was 
born. In the process of defending himself against onsets of severe rage and 
hatred, he became afraid of action and withdrew into a kind of vita contemplativa. 

In consequence, he was always kind and polite, but cold, without any real con- 
tacts, longing to receive love and attain success without, however, any activity on 
his part. He withdrew from acting to talking, and in his daydreams he became a 
great orator who, merely by making speeches, won more admiration than others 
by their deeds. 

Theoretically, the difference between these reactions and hebephrenia may 
readily be defined. In the inhibited states, the object relationships are impov- 
erished because the unconscious relationship to childhood objects must be held 
in check; in hebephrenia, the cathexis is actually withdrawn from the objects, 
not merely from external behavior. In clinical practice, however, it is not always 
easy to make this differentiation. Even in hebephrenia the narcissistic regression 
may be a gradual one, and incipient hebephrenics, too, present a picture of ex- 
tremely apathetic individuals with deep underlying conflicts over their hostility 
to objects {see p. 423). 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT ^^7 
ANXIETY NEUROSIS 

The dammed-up state creates a relative insufficiency of normal ego control. 
Actually, the first clinical symptoms of actual neuroses are very similar to those 
of traumatic neuroses. The neurotic, being engaged in an acute inner defense 
struggle, becomes restless, agitated, upset, and feels that he needs some change 
but does not know what it should be. He, too, then develops symptoms in the 
form of “emergency discharges,” such as apparently unmotivated emotional 
attacks, chiefly anxiety spells, and disturbances of physical functions which are 
in part inhibitions and in part equivalents of anxiety. 

As a matter of fact, even in actual neuroses, these general symptoms often 
appear in a more “specific” form, which is determined by the history of the per- 
sonality. 

Such patients feel tense and do not know what to do to make relaxation pos- 
sible again. Very often they refuse to go to bed at night because they cannot 
achieve the relaxation necessary for sleep, and those with yearnings for the 
earlier oral-receptive type of mastery cannot rid themselves of the idea that 
somebody must come to “liberate” them. Their not-going-to-bed becomes a kind 
of magical procedure to enforce this liberation. Frequently, vicious circles come 
into being when the patients become afraid of the violence of their own attempts 
to enforce magical help; they get fears of retaliation and therefore with still 
greater intensity refuse to go to bed, that is, to abandon control. 

The fact that attempts to increase the countercathexis in order to bind the ex- 
cessive amounts of excitation alternate with involuntary emergency discharges 
explains the aforementioned succession (or simultaneity) of hypomotility, with 
general lack of interest and with loss of elasticity, and hyperemotional restless- 
ness. The clinical picture is similar to that of a person whose sexual excitement 
is stopped before gaining its natural discharge. Actually the condition in both 
cases is the same. The difference consists only in the circumstance that the inter- 
ruption in the course of excitement is due to internal defenses, whereas in the 
case of interruption of sexual intercourse the disturbance is an external one (789). 
Actually, Freud’s advice is still valid: if a person suddenly becomes irritable and 
moody and develops spells of anxiety or a general readiness for anxiety, one 
• should first ask about his sexual life. Sometimes stopping the practice of coitus 
inter ruptus is sufficient to effect a cure (545, 547, 551). 

The anxiety in these states, like the anxiety in traumatic neuroses, is a direct 
and automatic expression of the state of being dammed up, representing, in part, 
simply the way the flooding by uncontrolled amounts of excitement makes itself 
felt and, in part, involuntary vegetative emergency discharges (11175 1371)* 

Reich pointed out that during sexual excitement typical autonomic nervous 
reactions occur. In normal sexual intercourse these autonomic cathexes become 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


1 88 

gradually transformed into genital ones, and find a genital outlet in orgasm. If 
the orgastic function is disturbed, this change does not take place. The autonomic 
system remains overcharged, and this fact produces anxiety (1270). 


POSITIVE NEURASTHENIC SYMPTOMS 

If the actual-neurotic state is characterized not so much by anxiety as by other 
emergency discharges, combined with the various symptoms described above, it 
is usual to speak of neurasthenia. This condition is psychoanalytically not pre- 
cisely defined; probably a more exact definition would be the task of further 
physiological research about the chemical transformations in excitement, satis- 
faction, frustration, and being dammed up. 

The positive actual-neurotic symptoms as vegetative discharges — nevertheless 
discharges, after other ways of discharging have been blocked — present a chal- 
lenge to physiology. A normal instinctual satisfaction means a physical (chemical) 
alteration at the source of the instinct. If an instinctual need is not adequately 
satisfied, the chemical alteration connected with the gratification of the drive is 
missing, and disturbances in the chemistry of the organism result. Undischarged 
excitement and affects mean an abnormal quantity and quality of hormones, and 
thus alterations in physiological functions {see p. 238). 

Freud once inclined to the belief that neurasthenic symptoms might be an 
outcome of exaggerated masturbation (558, 580). Probably a more correct formu- 
lation would be: Neurasthenia is an outcome of insufficient orgasm; it occurs if 
masturbation has become insufficient, that is, if anxieties and guilt feelings disturb 
the satisfactory character of the masturbation (1268). 

The physical symptoms of neurasthenia vary greatly, depending upon the 
constitution and the history of the personality. In the foreground of the picture 
are either retentive spastic symptoms as expressions of the attempts to block 
discharges, such as muscular and vasomotor spasms, constipation, and various 
types of headache, or explosive involuntary “emergency” discharges, such as 
diarrhea, sweating, tremor, and restlessness (201, 1010, 1381). 

There is a gradual transition from neurasthenic symptoms to real organ neu- 
roses in which retention and discharge symptoms are much more specific and in 
which intermediary factors are interpolated between defensive struggle and physi- 
cal expression {see p. 238). 


DISTURBANCES OF SLEEP 

If a person spends a night in an uncomfortable situation, such as an uncom- 
fortable sitting position, his sleep is more or less disturbed; he cither does not 
succeed in falling asleep or, having fallen asleep, he feels exhausted rather than 
rested the following morning. To achieve the complete fulfillment of the func- 



DIRECT CLINICAL SYMPTOMS OF TH£ NEUROTIC CONFLICT ^^9 

tion of sleep, tensions must be excluded from the organism, a prerequisite, im- 
possible in this case because of the uncomfortable position of the body. 

Neurotic disturbances of sleep are based on a similar impossibility of relaxa- 
tion. In the case of the uncomfortable position of the body this impossibility was 
externally determined, whereas in neurotic disturbances it is due to internal 
causes. Clinging to certain cathexes, despite the wish to sleep, has the same effect 
as has continued tension in certain muscles : either the state of sleep is not attained 
or, if it is, the function of sleep is disturbed and the effect on the organism is 
enervating rather than refreshing. After continued monotonous physical move- 
ments, falling asleep is usually very difficult because the muscular areas involved 
still tend to continue the movements. (It is interesting to note that if a person 
nevertheless does succeed in falling asleep, he dreams that he is still keeping 
up the movements; the unconscious meaning of such dreams is: “My sleep need 
not be disturbed by impulses to keep on skiing, riding, etc., for they correspond 
to my actions: I am actually skiing, riding, etc.”) 

The same condition, occasioned by an uncomfortable position or unconscious 
motor impulses, is even more frequently brought about by unconscious stimuli 
that resist the wish to sleep and still retain their cathexes. As is well known, the 
function of dreaming in general serves the purpose of making sleep possible 
even under the adverse condition of the continuance of unconscious cathexes 
(552), A quantitative increase in such dream-forming cathexes may endanger 
the possibility of maintaining the sleeping state through dreams. In a state of 
being dammed up, this inability to master the cathexes that resist sleep through 
dreams usually first becomes apparent in the frequent occurrence of dreams that 
fail, that is, in recurrent nightmares (876) ; and eventually sleep may become 
almost completely impossible (358, 441, 1113)- 

Furthermore, it is not only the cathexes of repressed wishes that may make 
sleep impossible. Acute worries or affect-laden expectations, whether agreeable 
or disagreeable, particularly sexual excitement without gratification, make for 
sleeplessness. In the case of neurotic disturbances of sleep, the unconscious fac- 
tors of course outweigh the others. 

The idea that the autonomy of the cathexes of the repressed, acting in opposi- 
tion to the wish to sleep, either makes sleeping impossible or impairs its refresh- 
ing effect is so plausible that one wonders how restful sleep is possible at all, since 
everybody has repressions. With particular reference to neurotics, one would 
expect that all of them would suffer from disturbed sleep. 

Actually the impairment of the functioti of sleep is one of the most common 
neurotic manifestations and is encountered in almost every neurosis (1152) ; how- 
ever, sometimes it is possible to explain why speh a disturbance is relatively slight. 
Some neurotics have learned to render harmless the sleep-disturbing stimuli 
coming from the repression by applying secondary measures, by channelizing 



19^ THE PSYCHOANALYTIC THEORY OF NEUROSIS 

themj jbowever, it must be admitted that this does not sufficiently solve the prob- 
lem. The fact that sometimes intense repressed cathexcs seem not to interfere with 
the relaxation necessary for sleep obviously depends upon still other (constitu- 
tional?) factors. It is certain that the sleep-disturbing effect of the repressed is 
greater for all those involved in acute defensive conflicts than for those who have 
learned to avoid acute secondary repression struggles through rigid ego attitudes. 

Some neurotic sleep disturbances are not of the general actual-neurotic type 
hitherto described. The ego opposing the warded-off impulses knows that these 
impulses push forward 'with greater force in the state of sleep or while falling 
asleep than during the wakeful state. Therefore, the ego fears the state of sleep or 
of falling asleep. This is the most general explanation of sleep phobias; fear of 
sleep means fear of the unconscious wishes that may arise in sleep (638, 1201). 
Frequently such a fear arises after the experience of a nightmare of traumatic 
effect. Fear of sleep then is a fear of dreaming, that is, of a failure of repression. 

There are very definite instinctual temptations which more frequently than 
others are associated with the idea of sleeping. Inasmuch as the voluntary control 
of motility is lost during sleep, it is first and foremost the fear of forbidden in- 
stinctual actions which can assume the form of fear of sleep (175)* h under- 
standable that children who are bedwetters, or adults who as children used to 
wet their beds, want to avoid sleep in order to avoid any opportunity for bed- 
wetting. That which is valid in childhood for the executives of urethral (or anal) 
functions is later valid for the executive of the genitals. We know that young men 
with conflicts of conscience about masturbation undertake to substitute nocturnal 
pollutions for masturbation because they then feel less responsible. But the super- 
ego does not always accept this excuse. The fear of sleep or of falling asleep is 
very often a fear of the temptation to masturbate. Further, the state of falling 
asleep is accompanied by a reactivation of archaic levels of ego consciousness, and 
archaic forms of ego experience have in turn frequendy become representatives of 
excitations experienced in the earliest period of development. Persons who have 
oral-erotic and skin-erotic repressions try to avoid everything that reminds them 
of the original period of their oral-erotic and skin-erotic excitations; and the ego 
states which they must experience when falling asleep arouse such recollections. 
These are, therefore, felt as prohibited temptations, which can become a motive 
for entirely avoiding the state of sleep or of falling asleep ’ (1594), The main 
neurosis of orality, melancholia, goes hand in hand with the most serious dis- 
turbance of sleep. A further specific instinctual temptation that may be suggested 
by the state of sleep is the remembrance of a primal scene, which took place at 
night when the child was supposed to be asleep. 

The unconscious association that disturbs sleep may also be a specific and 
unique one, explicable only by the life history of the individual (309). 

Frequendy, the state of sleep docs not signify a temptation but rather some 
punishment or catastrophe, associatively connected with certain drives. The fact 
that .the state of sleep precludes the free use of motility makes some persons fear 
sleep as an obstacle to their fleeing from supposed dangers or punishments. Not 
only may the unconscious thought arise that one may be castrated during sleep 
but the very loss of consciousness in sleep may itself have the meaning of castra- 
tion. 



DIRECT CLINICAL SYMPTOMS OF THE NEUROTIC CONFLICT ^9^ 


This is not the place to analyze the neurotic fear of death in detail; it is regu- 
larly due to unconscious conceptions associated with the ideas of dying or being 
dead and to a turning away from active impulses to kill {^see pp. 208 f.). If such a 
fear once has been established, it can easily lead to disturbances of sleep by equat- 
ing sleep and death with each other. 

Most frequently, however, disturbances of sleep unconsciously represent tempta- 
tion and punishment simultaneously. The curtailment of ego functions occurring 
in the state of sleep is at the same time feared as the loss of the ego’s censorship 
over the instincts, that is, as an opportunity to do anything one pleases, and as a 
minor death, as a castration, as a terrible consequence of pursuing instinctual 
activities. 

The conflicts around disturbances of sleep may have a further development. 
The ego undertakes various measures in order to regain the lost control, some- 
times with greater success, sometimes with less. An interesting example of such 
attempts may be observed in the sleep rituals of compulsion neurotics. Sleep is 
possible only as long as certain measures are carried out, which are intended to 
exclude the danger that is unconsciously associatively connected with the state 
of sleep (441 )• 

The pavor nocturnus of children, as well as the occurrence of frequent night- 
mares, is a failure of such measures; the repressed, and thereby the fear of it, 
returns and disturbs sleep (123, 1098, 1232, 1341, i343> 1407? 1548)- 

The manifold possibilities of sleep phobias should not mislead one into under- 
estimating the more important actual-neurotic side of neurotic disturbances of 
sleep. In general, sleep presupposes a total relaxation; and a state of inner tension 
is therefore connected with the disturbance of sleep. 


GENERAL REMARKS ABOUT CHRONIC NEURASTHENIA 

If an actual neurosis is not due to a mere external disturbance of libidinal 
economy but rather to a defensive struggle, the state of being dammed up, after 
a certain time, is usually further elaborated. However, there are certain forms 
that remain on the level of neurasthenia. It is not easy to state what causes such 
a. development (201, 1381). What can be stated with certainty is that the excite- 
ment, which cannot find any oudet, in such cases is exclusively pregenital in 
nature; in chronically neurasthenic individuals, even the genitals appear uncon- 
sciously to serve pregenital aims (1268). This circumstance may, for example, 
find expression in the symptom of ejaculatio praecox (14; <:/. also 477). Sometimes 
analysis of the form of the masturbation suffices for the recognition of its pre- 
genital latent content (1262). Since the attempted satisfaction never can be 
achieved, the patients try masturbation again and again, and this explains why 
compulsive masturbators and their extreme types, masturbation addicts {see 
p. 384), are frequendy chronic neurasthenics. Masturbation may become the 
uniform response to any kind of stimulus. 

A disturbance of the economy of the instinctual demands is the more likely 



192 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


to produce lasting effects, the less able the person is to treat difficulties actively, 
that is, the more he inclines toward passive-receptive longings. Actually chronic 
neurasthenics arc always persons with a heightened narcissistic need. The types 
that will later be described as impulsive personalities, addicts and persons dis- 
posed to depressions, are often at the same time chronic neurasthenics. 

It is understandable that some of the actual-neurotic symptoms, especially the 
physical ones, are very painful. Since a medical examination in such cases can- 
not find any cause for the pains, the complaints of the patients often are called 
hypochondriacal. And actually, there is not always a sharp borderline between 
neurasthenia and hypochondriasis {see p. 262) . 

THERAPEUTIC PSYCHOANALYSIS IN ACTUAL NEUROSES 

With regard to therapy, those types of actual neuroses that are due to an un- 
fortunate sexual regimen do not need any other therapy than a change of this 
regimen. Likewise, acute states of “nervousness” due to some specific experience, 
which upset the equilibrium between defensive forces and warded-off instincts, 
are frequently only temporary and end spontaneously when a new equilibrium 
is found. Cases in which an acute neurosis can be caught in statu nascendi, as 
long as actual-neurotic symptoms still are more in the foreground than psycho- 
neurotic symptoms, often are readily accessible to psychoanalysis; and for states 
of anxiety that can be caught before the anxiety is finally fixated on a certain 
object, an especially good prognosis can be given. In contrast, the prognosis is 
poor in cases of chronic neurasthenia and hypochondriasis. It will become clear 
later why the lack of genital primacy and narcissistic orientation greatly hamper 
the therapeutic possibilities of psychoanalysis. 

Actual-neurotic symptoms become further elaborated in different ways. Some- 
times the symptoms themselves impress the patient in a traumatic way; he then 
may develop a kind of secondary traumatic neurosis {see p. 457). The sensations 
may unconsciously be interpreted as castration or as the loss of protection by the 
superego, which may be met by an intensification of the defending forces, and 
thus create a vicious circle. In cases with narcissistic fixations, actual-neurotic 
symptoms may induce increased self-observation and form the core of a hypo- 
chondriasis. And, last but not least, actual-neurotic symptoms may be trans- 
formed into psychoncurotic symptoms by a further and more specific elaboration. 

Actual-neurotic symptoms form the nucleus of all psychoncuroses. Unspecific 
anxiety and general irritability and moodiness are present at the start of any 
psychoncuposis (392, 447). Actual-neurotic symptoms may also reappear at the 
conclusion of a psychoneurosis: if psychoanalysis succeeds in freeing a patient’s 
repressed sexual energies, but the external ‘situation prevents him from finding 
an opportunity for achieving the satisfaction of which he is now, capable, psycho- 
neurotic symptoms may again be replaced by actual-neurotic ones. 



C Psychoneuroses. Mechanisms of Symptom 
Formation, and Special Neuroses 

CHAPTERS XI-XVIII 


Chapter XI 

ANXIETY AS NEUROTIC SYMPTOM: ANXIETY 

HYSTERIA 

THE NATURE OF THE PSYCHONEUROTIC SYMPTOM 

A CHANGE in a state of being dammed up, caused by a neurotic conflict, seems 
possible only through a break-through of the original impulse or through an 
intensification of the defense. Actually, however, there is a third possibility 
which at first glance seems paradoxical: both may occur simultaneously. Com- 
promises are found in which the objectionable impulse finds some substitute 
outlet, but the substitute outlet may help to ward off the remainders of the 
original impulse. A part of the dammed-up energy is discharged, but in such a 
way as to intensify the defense against the rest. The typical neurotic symptom 
expresses drive and defense simultaneously. Slips, errors, and symptomatic acts 
constitute comparatively simple examples wherein the formation of compro- 
mises of this sort can be studied in relative isolation (553). 

The great reservoir for substitute formations is constituted of daydreams. 
Wish-fulfilling fantasies which are developed as playful refuge and as a substi- 
tute for unpleasant reality {see pp. 49 f .) can easily be used as derivatives by 
warded-off impulses. Such fantasies, being intensified by the displacement of the 
cathexis of warded-off impulses, may offer a substitute discharge; but if they in- 
crease excessively or come too close to the repressed content, they in turn may be 
warded off. Neurotic symptoms, then, are not always direct expressions of the 
repressed impulses, but rather indirect ones determined in their specific form by 
derivative daydreams that are interpolated between the original impulse and 
the final symptom (590), 

The simplest example for a derivative that may or may not find an outlet is 
given in an exaggerated or qualitatively changed affect. If a person reacts to an 
event in an exaggerated way or with a type of affect that seems inadequate, this 
is a sign of displacement; the affect actually belongs to some other situation 
which had been warded off. 


194 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


The production of derivatives and the struggle of these derivatives for admis- 
sion to motility are regulated by special mechanisms of symptom formation. The 
prevailing mechanisms of symptom formation determine the symptomatology 
and clinical course of a neurosis. Consequently the following chapters which 
deal with the mechanisms of symptom formation will at the same time examine 
the characteristics of the specific psychoneuroses. 

It must be stressed, however, that practically all cases of neurosis exhibit vari- 
ous mechanisms of symptom formation concurrently. Freud stated definitely 
that in every compulsion neurosis there is a nucleus of conversion hysteria (599) 
and that behind every neurosis in general there is an infantile anxiety hysteria 
(618). Present-day character disorders, in which the ego itself is drawn into 
the illness, are multiform in regard to their underlying mechanisms. It is more 
exact, therefore, to diagnose mechanisms than to diagnose neuroses. 

However, in any branch of medicine, diagnosis and special pathology are of 
relative value only. No single clinical case ever presents a disease entity as it is 
described in the textbook. Nevertheless everyone recognizes the theoretical and 
practical importance of diagnosis and special pathology. Certain features may 
differ from the typical, but by and large typical features prevail and only an 
understanding of the typical gives a foundation for an understanding of the 
atypical. In psychoanalytic investigation the customary method of procedure is 
to attain understanding of the usual complicated phenomena by a preliminary 
study of more unusual but more transparent examples. In the study of the neu- 
roses, the typical mechanisms of symptom formation represent just such more 
readily understood instances. They represent typical components, atypical com- 
binations of which constitute the majority of actual individual neuroses. In this 
sense we shall proceed from the simpler to the more complex. The descriptions 
of mechanisms that follow do not imply that the mechanisms always or even 
very frequently occur in these isolated forms. The chief value of the classification 
is a heuristic one. 

ANXIETY IN ANXIETY HYSTERIA 

The simplest compromise between drive and defense consists of the anxiety 
that was the motive for the defense becoming manifest, whereas the reason for 
the anxiety is repressed. 

In anxiety neurosis, a general inner tension manifests itself as a constant, 
freely floating anxiety or readiness for anxiety. In anxiety hysteria, however, 
the anxiety is specifically connected with a special situation, which represents 
^ the neurotic conflict. 

If the ego that appraises the danger — ^‘‘This instinctual action or situation may 
. bring castration or loss of love’* — intends to *‘warn” in the same sense as a normal 
lego warns of a real danger, in anxiety hysteria this intention entirely fails. What 



ANXIETY AS NEUROTIC SYMPTOM; ANXIETY HYSTERIA ^95 


was intended to prevent a traumatic state actually induces one. This state of 
affairs was mentioned in connection with the triple stratification of anxiety, 
,where it was stated that in such cases the warning anxiety regresses to panic 
anxiety {see p. 133). This failure of the warning function of the ego finds its 
explanation in the fact that a heightened inner tension (the state of being 
dammed up) had previously created a general readiness for anxiety, a powder 
keg in which the danger signal of the ego acts like a match. 

A tense person reacts to a danger situation differently from a normal person. 
The normal person develops a certain fear which may be used by the ego. The 
tense person develops a latent readiness for explosion which, through an addi- 
tional influx of fear from the perception of danger, causes him to become para- 
lyzed. In the same way that a “nervous” person reacts to a real danger with 
panic instead of feeling fear and reacting accordingly, he also reacts to an imag- 
inary danger with panic. 

Most often a diffuse readiness to develop anxiety of the nature of an anxiety 
neurosis has existed for a certain period. Then something occurs which uncon- 
sciously mobilizes the basic pathogenic conflict. The ego intends to warn, the 
warning fails, and the first spell of the anxiety hysteria occurs. From then on the 
readiness to develop anxiety is bound to the specific situation that aroused this 
first anxiety spell. The limitation and specification of the feared situation can be 
described as a kind of secondary binding of the primary diffuse anxiety to the 
specific content (392, 873, 875). The continual explosive readiness in anxiety 
neurosis is now controlled as long as no matches of allusion to the specific situa- 
tion are lighted. However, if these specific situations are touched upon, the 
anxiety becomes manifest. Secondarily the ego develops measures that attempt to 
fight off this anxiety, too. Anxiety hysteria, in which the fear that motivated the 
defense is still manifest, is the simplest kind of psychoneurosis. Thus the first 
neurotic reactions in children have, as a rule, the character of anxiety hysterias. 
All the other neuroses have elaborated the anxiety further. 

THE DISPLACEMENT IN ANXIETY HYSTERIA 

What determines the choice of the specific content .f* What situations or persons 
arc believed to be dangerous? 

In certain cases there is not much displacement; anxiety is simply felt in situa-' 
tions where an uninhibited person would experience either sexual excitement 
or rage. In discussing inhibited states, it has been mentioned that an inhibition 
sometimes manifests itself in a certain fear that is developed whenever the in- 
hibited field is touched upon. Besides impotence and frigidity, there is also a 
sex phobia; that is, some persons, especially women, become frightened in the 
face of sexual temptations and try to avoid them. There are general eating 



19^ THE PSYCHOANALYTIC THEORY OF NEUROSIS 

phobias, and more specialized phobias about special kinds of food that have 
become connected with unconscious conflicts, either through historical associa- 
tions or through their symbolic significance. There are anal phobias which try 
to avoid anal excitations at any cost. There are fighting phobias, seen in persons 
who become frightened whenever aggressive behavior would be indicated. For 
such cases, a formula is valid which would be an oversimplification in more 
complicated cases : what a person fears, he unconsciously wishes for. 

In other and still simple phobias, the feared situation does not represent a 
feared temptation; rather, it is the threat that causes the temptation to be feared: 
castration or loss of love. There are knife and scissor phobias, the implication of 
which is that the touch or even the sight of these instruments awakens the 
feared thought of a possible castration (and, it is true, in most cases also an 
unconscious temptation for a repressed hostility). Certain persons are afraid of 
seeing cripples or of witnessing accidents, which means: “I do not want to be 
reminded of what might happen to me” (and, again, the fear may also arise from 
such sights being a temptation for unconscious hostile wishes). Small children 
are afraid of being left alone, which for them means not being loved any more. 

The fear of being turned into stone through a forbidden sight does not only 
mean death (and castration) but also expresses fear of the sensations of anxiety 
themselves. The idea of being stone represents the idea of being paralyzed by fear. 

All these cases are characterized by their lack of displacement. More frequent, 
however, are cases of anxiety hysteria in which the defensive forces have achieved 
more than a mere development of anxiety and subsequent phobic attitudes. The 
connection between the feared situation and the original instinctual conflict has 
become more concealed. It is not sexual situations that are feared any more but 
rather sexualized situations. Regularly the feared situation or persons have a 
specific unconscious significance for the patient. In a more distorted way, they 
again symbolize either a temptation for a warded-off impulse or a punishment 
for an unconscious impulse or a combination of both. 

This also holds true for all neurotic misapprehensions of actual events in terms 
of the past, even if not accompanied by patent anxiety: the warded-off impulses 
seek opportunities for satisfaction, but their reactivation likewise mobilizes the 
old anxieties; the neurotic repetitions consist in misunderstanding actuality in 
the sense cither of unconscious temptations or of unconscious punishments or in 
both senses. 

Examples of anxiety situations that represent unconscious temptations: The 
idea of open streets in agoraphobias is, as a rule, unconsciously conceived as an 
opportunity for sexual adventures. The idea of being alone is perceived of as 
temptation to masturbate. 

Examples of the punishment character of anxiety situations: The feared street is 
thought of as a place where one might be seen and caught; being alone means 



ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTERIA ^97 


being unprotected against the punishing powers of the bogeyman. What anxiety 
hysterics fear often represents substitutes of the idea of castration. In little Hans, 
the unconscious meaning of the fear of being bitten by a horse was a regressive 
oral expression of the idea of being castrated (566). Another patient, who was 
afraid of being bitten by a dog, was astonished when analysis revealed that this 
fear, judging by the accompanying physical sensations, actually referred to his 
genitals. 

Many hypochondriacal fears mean either ‘T may become castrated*’ or “It may 
turn out that I am already castrated.” There are sickness phobias in persons during 
whose childhood castration fear was displaced to the idea of being sick. Fre- 
quently, in such cases “being sick” means “having fever,” the sensations of the 
feverish state representing the feared infantile sexual excitement. 

An example of the simultaneity of temptation and punishment is given in the 
case of the wolf-man (599). He had developed a passive-feminine attitude toward 
his father, and was afraid that the satisfaction of these feminine wishes might 
carry with it the dreaded castration. His fear of being eaten by the wolf was simul- 
taneously a regressive oral expression of the wish to submit to his father and of 
the threat of being castrated. 

Fears of being run over or of falling from a high place are typical expressions of 
feminine masochistic wishes ancf, at the same time, of the connected castration 
fear (884). Falling from a high place, connoting the danger of being killed, cer- 
tainly represents punishment, probably most often punishment for wishes of kill- 
ing; however, the sensation of falling itself simultaneously represents the sensa- 
tions of sexual excitement which, having been blocked in their natural course, 
have acquired a painful and frightening character. The fear of being confined 
in a narrow space or a fear of narrow streets signifies the fear of the very sensations 
of anxiety which arc experienced as a constriction and augmented through the 
painful vegetative sensations that replace blocked sexual excitement. Fear of 
high places later may be replaced by the conversion symptom of getting dizzy 
spells when looking down from high places. This symptom is physical expression 
of a mental anticipation of actual falling. 

A simultaneity of punishment and temptation is, as a rule, also the basis of the 
frequent fear of “going crazy,” With regard to this fear, it should be kept in mind 
that it may be justified. The rule that a person who is afraid of insanity docs not 
become insane is not true; many incipient schizophrenics are aware of their in- 
creasing estrangement. However, more frequently this fear is not a warranted 
judgment but is rather a phobia. Even as a phobia the fear has an objective basis: 
what the patient senses in his fear of becoming crazy is the interaction of his 
unconscious strivings, especially the instinctual (sexual or aggressive) impulses 
operative within him (871). In this sense, the fear of going crazy is but a 
special case of the general fear of one’s own excitement. Since the feared excite- 
ment of infantile sexuality is most often experienced in connection with masturba-, 
tion, the warnings of adults that “masturbation drives people crazy” may easily 
be accepted by children as a substitute for the idea of castration. 

Sometimes the idea of insanity has, unconsciously, a more specific significance. 
Experience may have established the equation head ^ penis, and therefore in- 
sanity = castration, A child may, depending upon various experiences, connea ^ 
v^ious ideas with insanity. The idea of being an idiot is sometimes connected 



198 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

with the idea of having a big head (hydrocephalus) which, as a representation by 
the opposite, again may mean castration. Babies have big heads; older siblings 
often hate babies and are, therefore, afraid of hurting them. 'T might become an 
idiot like the baby” or “I might get a big head like the baby” may represent both 
the feared envy of the baby and the anticipated punishment for this envy. 

Fears of being ugly or dirty may have the same significance as fears of being 
sick or insane; ugliness or a repelling appearance means being sexually excited 
(or being in a rage) or being castrated (or pregnant) or both. Phobias of this 
kind may form a transitional state toward delusions. 

Still another example for a simultaneity of temptation and punishment is given 
by the states which Ferenezi has described as Sunday neuroses (484). On Sundays, 
some persons regularly suffer from anxiety (or from depressions). Sundays gen- 
erally are looked upon as days when sexual activities are more likely to occur than 
on other days; but Sundays are also the days on which children are more under 
the supervision of their fathers. 

What, now, is the relation between the manifest anxiety situation and its 
unconscious instinctual significance 

The fact that there is a displacement at all certainly is traceable to the defense, 
which makes the original ideas unconscious and thus necessitates the develop- 
ment of substitutes. The substitute, as Freud formulates it, “on the one hand has 
certain associative connections with an idea which was rejected; while on the 
other hand, because of the remoteness of that idea, it escapes repression*’ (590). 

The displacement shows that in anxiety hysteria the defense is not limited to 
the development of anxiety or to avoidance of situations in which the anxiety 
would occur. The development of substitutes proves that repression and other 
defense mechanisms are used as well. The anxiety in anxiety hysteria initiates a 
pow'erful repressive activity. 

Due to repression, phobias frequently have an indefinite, nebulous content, 
comparable in their lack of clarity to the manifest content of dreams; it often 
takes a great deal of analytic work to ascertain precisely what the patient is 
afraid of. In some cases the content of the fear had at one time been clear and 
definite, but later in the course of the neurosis it became vague and indefinite. 
The forces of repression continue to wage war on the symptom as an offshoot of 
the repressed. Thus an understanding of a complicated or vague symptom of long 
standing may frequendy be attained by determining the circumstances of its first 
appearance. 

The advantage offered by the displacement is that the original offensive idea 
does not become conscious. To be afraid of a horse instead of the father, as in the 
case of little Hans (566), has certain other advantages, too. Those who threaten 
are hated. If an individual no longer feels threatened by his father but by a 
horse, he can avoid hating his father; here the distortion was a way out of the 
conflict of ambivalence. The father, who had been hated and loved simultane- 
ously, is loved only, and the hatred is displaced onto the bad horse (618). Freud 



ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTERIA ^99 


also brings to our attention the fact that a boy is forced to associate with his father 
every day, whereas the threatening horse can be avoided simply by not going 
outdoors. To fear the wolf instead of the father (599) has still further advantages: 
horses were frequent in city streets in Hans’s time, whereas wolves are to be seen 
only in picture books which one does not need to open, or at the zoo where one 
does not have to go very often (618). If a person has become afraid of going 
out, it is possible to avoid this feared situation, whereas one’s own body and its 
sensations cannot be avoided; an advantageous projection from an internal in- 
stinctual danger to an external perceptional danger has taken place. 

A projection of this kind, that is, the attempt to escape from an internal dan- 
gerous impulse by avoiding a specific external condition which represents this 
impulse, is the most frequent type of displacement in anxiety hysteria. It is true 
that the original danger, in the last analysis, also was an external one, for it is not 
the instinctual expression that is feared but its external consequences (castra- 
tion, loss of love). But although the phobic individual primarily flees from his 
threatening parents, he nevertheless is in flight from his own impulses; for the 
external danger of castration is determined by his behavior. 

The projection is more clearly evident in cases in which anxiety over an ex- 
ternal object has supplanted a guilt feeling; an object in the external world is 
now feared instead of one’s own conscience. 

In certain animal phobias, the projection of one’s own feared impulses is still 
more pronounced than it was in little Hans, A case described by Helene Deutsch 
had the following simple construction. An unconsciously passive-feminine young 
man was afraid of hens because they reminded him of his libidinous wishes and 
of the danger of being castrated, with which these wishes were associatively con- 
nected. He merely projected his internal instinctual conflict onto an avoidable 
external object (327), 

Often not only the goal of an impulse is projected onto an external object 
but one’s own sensations of excitement as well. 

A projection seems to be lacking, however, in children’s neuroses, when the 
feared external object “animal” simply replaces another feared external object 
“father.” 

The paths selected by the displacement are determined by various factors. To a 
considerable extent they are determined by the history of the individual. The 
significance of phobias cannot, therefore, be understood without taking into con- 
sideration the patient’s history. In part the paths of displacement depend on the 
nature of the drives that are' warded off. Anxiety over being eaten, for example, 
may correspond to oral-sadistic longings, anxiety over being murdered to death 
wishes. 

It has been mentioned that anxiety over being eaten or over being bitten 

may be a disguise for castration anxiety. In such a case the castration fear has 



200 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


become distorted in a regressive way, that is, by choosing as a substitute an archaic 
autonomous fear. The regression may be a partial one, and frequently we see 
manifestations of anxiety that contain elements of both being eaten and being 
castrated. Among manifestations of this kind are the fantasies of the vagina 
dentata, and that of intrauterine castration (414). 

Phobias about infection and touching often express the tendency to avoid dirt, 
and show that the patient has to defend himself against anal-erotic temptations. 

Again it is possible that genital Oedipus wishes have been regressively replaced 
by anal impulses, and that in this way castration anxiety has regressively been 
supplanted by anal fears. The frequent bathroom and toilet phobias which are 
observed in children and in compulsion neurotics, such as a fear of falling into the 
toilet, of being eaten up by some monster coming from it, or the rationalized fear 
of being infected, as a rule show signs of a condensation of ideas of dirt with 
castration ideas. 

Fear of open streets is often a defense against exhibitionism or scoptophllia. 
The role of these two partial instincts is even more prominent in phobias con- 
nected with appearing in public, whether this appearance involves special con- 
ditions such as being looked at (stage fright) or is merely a fear of being in a 
crowd. 

The anxiety attacks of a female patient with agoraphobia and crowd phobia 
had the unconscious definite purpose of making her appear weak and helpless to 
all passers-by. Analysis showed that the unconscious motive of her exhibitionism 
was a deep hostility, originally directed toward her mother, then deflected onto 
herself. “Everybody, look!” her anxiety seemed to proclaim, “my mother let me 
come into the world in this helpless condition, without a penis.” Originally the 
attack represented an attempt to exhibit a fantasied penis; the knowledge that 
this object was fictitious produced the transformation from perversion to anxiety 
hysteria. 

The aforementioned fears of being ugly or otherwise repulsive (e.g., of exud- 
ing a bad odor) reveal themselves as fears of one’s own exhibitionism. Persons 
with such fears are unconsciously striving to show their sexual excitement and 
are afraid of being rejected or punished for it. Further, this exhibitionism often 
has an aggressive, mandatory meaning. The patients may feel entitled to com- 
pensation and try to force by magical means the persons looking at them to give 
this compensation. The fear is that this intention may fail The ugliness may 
represent pregnancy or the state of being castrated; making a demonstration of 
it may signify a magical gesture, as exhibitionism often is intimately connected 
with an equally strong scoptophilia. If the fear of being ugly or “stinky” is replaced 
by the conviction that this is the case, this is a transitional state toward delusion, 
as crythrophobics in general arc prone to develop paranoid trends. The basic 
underlying feeling is one of guilt. In women the conviction of being repulsive 
(or ugly or physically disabled or unable to bear healthy children) is based on an 



ANXIETY AS NEUROTIC SYMPTOM! ANXIETY HYSTERIA 201 

awareness of their lack of a penis, an idea that is connected with masturbatory 
and incestuous guilt feelings; likewise in boys, an anxiety of this kind usually 
means that the terrible consequences of masturbatory activities may be found out. 

In a case of perfume addiction, this symptom could be traced back to a previous 
fear of exuding a bad odor. The patient was fixated on an anal concept of sex- 
uality. She was not only afraid that an early anal masturbation might be found 
out but also that she might give expression to her sexual longings, which were 
colored by a sadistic, castrating attitude toward boys and which she perceived in 
the special form of exuding an odor in their direction. 

Stage fright and erythrophobia, however, are most often not simple expressions 
of the warding off of heightened exhibitionism and scoptophilia. The fact that 
the exhibitionism has been heightened is, as a rule, the result of other previous 
instinctual conflicts, the exhibition not only being aimed at producing sexual 
pleasure but also at producing or enforcing reassurance against anxieties, guilt, 
and inferiority feelings. The anxiety hysterias in question represent the failure 
of such strivings for reassurance. The idea is by magical gestures to force spec- 
tators to prove that no castration has occurred, or to give the approbation needed 
to contradict a guilt feeling; if the spectators do not fulfill these demands imme- 
diately and adequately, violent (oral) sadistic tendencies may be developed 
against them. Thus the unconscious content of erythrophobic and stage-fright 
types of fear (and shame) is not only the idea that exhibitionistic actions may 
provoke castration or loss of love, but more specifically the idea that what is done 
to protect the person’s self-esteem against danger may result in the opposite, in 
his complete annihilation. And this again might be comprehended in different 
ways. Either the patient believes unconsciously that he is castrated and fears 
that his attempts to deny it might fail and that everything that was intended to 
make people like and feed him might result in their disliking him and with- 
drawing all support or he may be afraid of his own charming power: the sight 
of him might hurt and castrate the spectators and they will not be able to give 
anything any more; he is afraid of his own violent aggressiveness, often reduced 
to “aggressive looking” (96, 118, 356, 405, 446, 501, 522, 1085, 1568). 

A fear of examinations is closely related to erythrophobia and stage fright. 
However, some of the above-mentioned features arc here still more outspoken: 
an authority, an external representative of the superego, is about to decide 
whether one is accepted and permitted to participate in certain privileges, that 
is, to obtain the narcissistic supplies, or whether one is rejected and sentenced 
to isolation and narcissistic hunger. The relationship between modern examina- 
tions and primitive initiation rites has rightly been stressed (523, 1481). How a 
person reacts to this situation depends both on his sexual feeling relationship to 
authorities (to the father) and on his narcissistic needs. An anxiety hysteria will 
result whenever the person sexualizes the examination situation in the hope of 



202 XHE PSYCHOANALYTIC THEORY OF NEUROSIS 

thereby overcoming his inferiority feelings and castration fear, and then has to 
face the possibility of his efforts having the opposite result. Usually, conflicts 
around passive-feminine longings complicate the situation in examination pho- 
bias (105, 158, 405, 866, 1256, 1344, 1520). 

Other typical phobias are directed against other partial instincts. Anxieties of 
high places frequently are connected with unconscious ideas concerning erection, 
Claus tro phobias and fears of suffocation are often specially directed against fan- 
tasies of being in the mother’s womb (1056). Fears of falling, of heights, car and 
railway phobias, show at first glance that they are developed in an attempt to 
fight pleasurable sensations connected with equilibrium stimulation. 

This last factor, the struggle against sexual excitation as perceived in the 
pleasurable sensations of equilibrium, plays a special part in many anxiety 
hysterias. 

Abraham has shown that it is not only exhibitionism and scoptophilia that 
are warded off in agoraphobia; in cases of fear of going out onto the street, the 
function of walking itself has acquired a definite sexual meaning, which presup- 
poses an intensified equilibrium eroticism, possibly due to a fixation at the time 
of learning to walk (6, 9; c/. also 1282, 1402). 

A patient’s agoraphobic fears were accompanied by the feeling that his legs 
were being pulled, or that they were running away of their own accord. Analysis 
showed that the prohibition of his masturbation coincided in time with his learn- 
ing to walk. As a little boy, he took much pleasure and narcissistic pride in 
walking. His legs and their functions had usurped the place of the thwarted 
functions of his penis. A subsequent intensification of old conflicts permitted the 
fear of castration to become manifest, in the new field, as a fear of losing his 
legs (410). 

Once this has attracted attention, it can be realized that many phobic fears 
directly concern sensations of equilibrium. 

Sensations of equilibrium play an important part as a source of sexual excite- 
ment in children as well as in adults. Since sensations of the same sense generally 
are also an essential component of the experience of anxiety, connections between 
sexual excitement and anxiety are closer in the case of equilibrium eroticism than 
in any other partial instinct. Conflicts around erogenous sensations of equilibrium 
give rise to equilibrium phobias; but also the development of phobias in general, 
that is, the establishment of a close connection between sensations of anxiety and 
of sexual excitement, mobilizes infantile equilibrium eroticism. Often sensations 
of equilibrium have become the representatives of infantile sexuality in general. 
Many persons who have no conscious memory of having masturbated as chil- 
dren do remember various games and fantasies involving the situation of their 
body in space, about changes in the size of their body or of certain parts of their 
body> of ideas of their beds being turned around, or of still vaguer sensations: 



ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTERIA ^^3 

'‘Something is rotating.” Other persons do not remember any pleasure con- 
nected with sensations of this kind but do remember anxieties about them, 
alienations of the body or of certain organs, or fears about space sensations, all of 
which are the result of the repression of an older pleasure. Anxieties of this kind 
very often form the core of anxiety hysterias (444). 

PROJECTION OF ONE’S OWN EXCITEMENT IN ANXIETY HYSTERIA 

These facts must now be connected with the role played by projection in anx- 
iety hysteria. In many phobias the physical state of sexual or aggressive excite- 
ment (frequently expressed in sensations of equilibrium and space) is projected 
and represented by a feared external situation (526, 1384, 1386, 1391). Persons 
who are afraid of falling asleep or of being anesthetized or of having fever are 
chiefly afraid of being overwhelmed by painful sensations of equilibrium and 
space. Often patients are afraid of monotonous noises, such as the ticking of a 
clock or other rhythmic occurrences; actually they are afraid of their own heart 
beat (or genital sensations) which are represented to them by what they notice 
in the external world. 

In claustrophobias, the idea of being confined is not experienced so pressingly 
if there is any possibility of escape. The anxiety increases to the utmost when 
the idea arises that one might want to leave the room and be unable to do so. 
Mostly the feeling is that sudden suffocation might occur and that in this event 
there must be a way of escape. Persons who are afraid of trains, boats, and air- 
planes state that the worst fear is the impossibility of getting out if they should 
so desire, and that when on a train they hold their breath from one station to 
the next. That means that the excitement is projected onto the vehicle that 
precipitated the excitement, and the need for a sudden escape from the room 
in which one is confined is a need for escape from one’s own feared excitement 
as soon as it has reached a certain intensity (431, 1522). 

Phobias of vehicles, rooted in the warding off of erogenous sensations of equi- 
librium and space, have definite relations to the somatic disease of seasickness. 
The vegetative excitements aroused by equilibrium sensations in a purely physi- 
cal way have a distinct similarity to sensations of anxiety, and these excitements 
may have become associatively connected with “too much sexual excitation” in 
childhood. Neurosis and seasickness, then, may influence each other. Persons 
with claustrophobia and similar neuroses probably tend more toward the develop- 
ment of seasickness; and an occasional seasickness in a hitherto nonneurotic 
person may mobilize infantile anxieties and have the effect of a trauma reactivat- 
ing the memory of a primal scene. There are also conversion hysterias which arc 
an elaboration of vehicle phobias in the sense that vomiting or dizziness, as a 
physical anticipation of feared equilibrium sensations, may have supplanted the 
anxiety. 



204 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

There are also “claustrophobias in time” rather than in space. Some patients 
experience a fear of having no time, of always being “cooped up” by their duties, 
which is as oppressive to them as the space sensations are to the claustrophobic, 
and which also has the same psychological significance. Other persons are afraid 
of “broadness” in time; they hasten from one activity to the next one because 
empty time has for them the same significance as empty spaces for some agora- 
phobics. 

Clinical experience shows that certain types of neurotic indecision are based on 
the same fear. Any definite decision means the exclusion of the possibility of 
escape and is therefore avoided. Certain forms of stubbornness represent a highly 
emotional rejection of commands, which are sensed as closing the ways of escape. 

What is feared in an inordinate excitement is obviously a kind of breaking 
do^vn of the organization of the ego. 

A patient felt anxiety in a car only when somebody else, not when he himself, 
was driving. “Why should I be afraid,” he said, “if I can stop the car at any time.?” 

It is the loss of voluntary decision that is feared, frequently represented in the 
unconscious by the idea of loss of control of bladder and rectum (557) > 
loss of control is represented by the vehicle’s moving uninfluenced by the wish 
of the passenger, by the room that cannot be left of one’s own volition, and 
originally by the increasing sexual excitement approaching orgasm. 

In Reich’s analysis of the normal and pathological course of sexual excite- 
ment, he has explained that a phase of voluntary movements is followed by one 
of involuntary convulsions of the muscles on the floor of the pelvis; in this second 
phase the act can no longer be interrupted voluntarily without intense displeas- 
ure; the full development of this phase is the condition for an economically 
sufficient discharge in orgasm (1270). This loss of the ego at the climax of sexual 
excitement is normally also the climax of the pleasure. Certain egos, the 
“orgastically impotent ones,” according to Reich (1270), do not experience this 
pleasure. For them, it turns into anxiety, loss of ego control and painful sensations 
of narrowness, suffocation or bursting. 

The train or the room represents one’s own body, or at least its sensations, 
which one tries to get rid of by projection. 

What has been said about claustrophobia in general is certainly true about the 
' special “mother’s womb” type of claustrophobia, the fear of being buried alive 
(406). The two interpretations, “The feared room represents mother’s womb” and 
“The feared room represents one’s own body sensations,” may be connected 
with each other by a third: “The feared room represents the interior of one’s own 
body” 

It is well known but not much discussed that the majority of agoraphobics ’ 
show specific conditions of their symptom related to the width of the feared 



ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTEI^IA 205 

Street. Sensations of narrowness are also a basic element of the expSirfcncc of 
anxiety. Persons whose excitement turns into anxiety feel a stricture in'-breathr 
ing, as if the chest had suddenly narrowed. (The opposite feeling of expansion, 
of being “broad” again, is physiologically connected with overcoming anxiety 
and is pleasurable; but representing a sudden change in the sphere of “broad- 
ness,” it may also serve, through “representation by the opposite,” as a symbol for 
getting frightened.) It is an attempt to protect oneself against painful sensations 
of narrowness (or broadness) if one feels the “street” and not the body as “nar- 
row” or “broad,” and this circumstance may explain projection in agoraphobia. 
Some patients are afraid of narrow streets only, others fear broad places, still 
others are paradoxically afraid of both; and most of them fear a sudden change 
in the width of the street through which they are passing. Many agoraphobics 
also show the condition whose significance has been discussed in claustrophobia: 
they have to make sure of the possibility of escape, which represents the wish for 
an escape from their own sensations. 


ANXIETY HYSTERIA AND ANIMISM 

When a phobic person passes through a narrow street, he gets frightened be- 
cause he feels as “narrow” as the street; he “introjects” the street’s narrowness. I£ 
his fear is intense, he may even feel a relatively broad street as narrow; he projects 
his own narrowness. For him, because of the way he experiences his anxiety, 
the conceptions of narrowness and fear are identical. The same feelings are 
aroused in him by a narrow street and by another frightened person. He even 
behaves as if the street itself were afraid. 

The primitive misapprehension of the world that assumes that processes we 
feel in ourselves also take place in the objects around us is called animism. The 
phobic mechanisms described make use of the animism still effective in the 
unconscious. 

One common type of animistic misapprehension of the world is very similar 
to the way in which the agoraphobics connect their feelings of fear with the 
narrowness of a street. Sachs described the role played by narcissistic projection 
in the feelings with which we react to nature (1329). “Consciousness of nature” 
does not consist in becoming aware of the real physical and geographical ele- 
ments in nature, but in becoming aware of feelings within ourselves, which we 
believe are connected with those physical or geographical elements {cf. 380). 

It is true that not all projections of feelings into nature connote nature’s be- 
coming a representative of our own feelings. Nature may also represent another 
person, and feelings connected with it may have originated in feelings toward 
that person. A mountain^ for example, may represent the father’s penis, the end- 
less ocean or desert may represent the mother’s womb. But even in emotions 



2o6 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


aroused by mountains or oceans in this way, the narcissistic element is not en- 
tirely lacking. A person sensing himself in a landscape does not simply feel love 
or hatred for the natural objects, but generally experiences a kind of identifica- 
tion with the landscape, the tinio mystica with “father’s penis” or “mother’s 
womb.” In general it may be assumed that in “consciousness of nature” a projec- 
tion of the kind described is at work. The esthetic categories used to describe 
landscapes are proof of that. We talk about “sublime” or “lovely” landscapes be- 
cause we feel sublime or lovely when seeing a landscape of this kind. It is true that 
the same landscapes vary in effect according to the mood of the observer; and 
it is likewise true that certain landscapes create, or at least mobilize, the same or 
similar feelings in different persons: the endlessness of flat prairies makes man 
melancholic, mountains make man more active and impulsive; this effect is 
achieved by the reflection of projections back onto the ego. 

There are numerous phobias (or preferences up to a certain intensity, and 
phobias beyond it) about landscapes, moods of the weather, light and shadow 
effects, times of the day, and so on. If these were collected and described in detail, 
they would teach much, not only about the projections in question but also about 
the historical connections between infantile sexual excitation and the feelings 
that later are projected. Probably many phobias of darkness or twilight contain 
memories of primal scenes. 

The same holds true for fears of surroundings that imply the loss of the usual 
means of orientation, fears of eternity, of uniform noises, of the cessation of 
customary routines or sequences. Some anxieties about jieath are anxieties over 
the loss of temporal orientation, that is, the loss of forces that protect against the 
dangerous world of unmastered infantile excitement (338). 


REGRESSION AND AGGRESSIVENESS IN ANXIETY HYSTERIA 

A common factor in all phobias is the regression to childhood. In childhood, 
dangers could be overcome by finding protection at the hands of more or less 
omnipotent objects in the external world. The phobic, who fears his impulses or 
the subsequent punishment, tries to regain that favorable situation where ex- 
ternal protection was available. In this sense, all phobics behave like children, 
whose anxieties are soothed if the mother sits by the bedside and holds their 
hand. Such a demand for reassuring measures on the part of parent substitutes 
is especially evident in those agoraphobics who feel protected in the presence of 
a companion. Since not all agoraphobics make this condition, the libidinal con- 
flicts around the person who is used as a companion cannot represent the basis 
of agoraphobia in general. However, in many cases the findings of Helene 
Deutsch (325) can be confirmed. She stated that in phobias in which the com- 
panion is essential, the relationship to this companion is of basic importance. 



ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTERIA ^^7 

The companion not only represents the protecting parent but also the uncon- 
sciously hated parent; his presence serves the purpose of diverting the patient’s 
mind from unconscious fantasies to reality, that is, of reassuring him that he has 
not killed this person who is walking safely at his side. In such cases, the fear 
that something may happen to the patient is often preceded by a fear for the 
safety of the same person who, later on in the agoraphobia, is used as a com- 
panion. 

A morbid fear for the well-being of one or several specific persons represents a 
frequent form of anxiety hysteria of its own. Analysis shows that the person who 
has to be protected represents an unconsciously hated person, who, therefore, 
actually needs protection not from external dangers but rather from inner death 
wishes (792, 1283). Often what has been repressed returns from the repression, 
and continuous caretaking or reassuring affection may become objectively a tor- 
ture. Especially frequently, parents show a behavior of this kind toward their 
children (618); however, sometimes children also show it toward their parents. 

The transformation of the earlier fear that the other person may be harmed 
into the phobic anxiety concerning oneself is due to a self-punitive identifica- 
tion with the unconsciously hated object. Many obsessive symptoms, which try 
to protect an unconsciously hated object in a more or less torturing and more 
or less magical way, represent this pre-stage of anxiety hysteria. These cases are 
clearly a transition to compulsion neuroses. 

On a superficial level the companion protects the patient from temptation. A 
man cannot approach strange women and a woman cannot be approached if both 
are in the company of their respective spouses. The youth or the girl cannot have 
adventures if accompanied by their parents. The idea that the companion watches 
brings relief from the necessity to watch one's own impulses. 

Freud has pointed out that the same procedure may give expression to numer- 
ous instinctual wishes. When a girl demands that her mother be with her con- 
stantly, she succeeds in fulfilling her unconscious desire to separate her mother 
from her father (618). The compulsion exerted upon the companion may gratify 
any hostile impulses in regard to this person. 

The fact that the regression to childhood in phobias is a search for protection 
against an instinctual danger is not always seen very clearly. 

Alexander writes about agoraphobia (53)* **Such a patient is afraid in a situa- 
tion which entails no danger for him. The symptom becomes intelligible only 
when one realizes that the patient has regressed to an early emotional attitude of 
childhood. As a child he felt safe only near his home and was afraid to go far from 
it. At that time, of course, his anxiety might have been quite rational because as 
a child he had not the capacity of sufficient orientation. The question in such a 
case is: why does the patient regress to such an unpleasant experience of his past? 
The analytic study then shows that this patient uses the symptom to barter a 
lesser evil for a greater. What he is really afraid of is not being far away from 



2o8 the psychoanalytic theory of neurosis 

home, but of loneliness and lack of human contact. He does not have the con- 
fidence that he can solve this problem in his actual life situation; his symptom, 
fear when on the street, helps him to deceive himself about this seemingly in- 
soluble issue. He persuades himself that he is afraid of the street, and thus 
saves himself the painful realization of how alone and isolated he is in his life. 
He also saves himself from the effort to build up a human relationship for which 
he feels inadequate and unwilling. This symptom has an additional determina- 
tion. The patient craves to be back in the past as a child when his dependent feel- 
ings were satisfied; however, putting himself back into childhood in fantasy he 
must also face the unpleasant side of childhood; childish insecurity and fear. 

However, the patient is not seeking the unpleasant experiences of his childhood 
as a lesser evil, but rather the relative security of that time, which came from the 
protecting adults. The actual anxiety of the neurotic which makes him long for 
the greater security of his past is not ^loneliness and lack of human contact but a 
remobilization of his infantile instinctual conflicts. 

The regression in anxiety hysteria in general, as in all hysterias, is a limited 
one; the main temptation which has to be warded off is represented by the wishes 
of the genital Oedipus complex. Phallic wishes and castration fears may be 
disguised in a pregenital form. However, there are also cases in which a pre- 
genital basis is more in the foreground. In some cases, the defense against aggres- 
she temptations plays the decisive part (282, 325, 797, 935). Sometimes the fear 
of one’s own excitement is based on the fact that this excitement actually contains 
self-destructive components which originate in a sadistic impulse, turned away 
from the object against the ego, so that a fear of death might appear under cir-^ 
cumstanccs which, in normal persons, would lead to an attack of rage, This 
is true particularly in cases where there is a combination of anxiety hysteria 
with compulsion neurosis, in which cases a relatively intense participation of 
destructive tendencies can be recognized, frequently by virtue of the associative 
bridge of the unconscious equation looking = eating (430) . The above-mentioned 
cases of street phobia in which a certain person is chosen as a protecting com- 
panion belong in this category. Their ambivalent conflict stands out sharply 

(325)- 

Even ambivalent persons without any agoraphobia often need a kind of com- 
panion, that is, an object supplying affection, interest, confirmation, protection, a 
kind of magical helper (653). The dependence on external supplies for the main- 
tenance of self-esteem is a sign of an early, usually oral, fixation. The relationship 
to magical helpers is necessarily an ambivalent one: the helpers are hated not only 
as representatives of the hated Oedipus object but also because of the inadequacy 
of their protective power. 

Aggression, of course, also plays a very considerable part in cases of anxiety 
hysteria centered aroimd a morbid fear of death (206, 207, 254, 1638). It is ques- 
tionable whether there is any such thing as a normal fear of death; actually the 
idea of one*s own death is subjectively inconceivable (591), and therefore prob- 



ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTERIA 209 

ably every fear of death covers other unconscious ideas. Certainly this is the 
case in intense and pathological death phobias. To understand them, one has to 
find out what ideas unconsciously are connected with the concept of death. 
Sometimes these ideas are libidinal in nature and become understandable 
through the history of the patient (284, 641, 1153, 1330, 1632). (For example, '‘to 
be dead” may mean a reunion with a dead person.) More frequently certain 
childhood experiences have turned a fear of castration or loneliness (loss of love) 
into a fear of death. Two connections are most often encountered: (i) The idea 
of death may be a fear of punishment for death wishes against other persons; it 
has been mentioned that certain perspns react with fear of death to situations 
where others would feel rage; this is obviously a turning of destructive im- 
pulses against one’s own person. (2) A fear of death may represent a “fear 
of one’s own excitement.” “Dying” has become an expression for the sensations 
of an overwhelming panic, that is, for the distorted conception which these 
patients have formed of orgasm. Every type of excitement tends toward ulti- 
mate relaxation. In cases in which the achievement of such relaxation is regarded 
as the terrible sensation of loss of one’s ego, it may be identified with “death,” 
and on occasions when other persons would hope for sexual excitement, death 
may be feared (1280). 

Another example of a phobia in which unconscious sadistic strivings are pre- 
dominant and which is, for the most part, combined with compulsion neurosis 
is the frequent fear of infection. The fear of being infected is, first of all, a ra- 
tionalized fear of castration. Venereal infection as a real danger connected 
with sexual activity may serve as a rationalization of unreal dangers uncon- 
sciously believed in (1614). On a deeper level, the fear of infection represents 
a defense against feminine wishes, infection standing for impregnation. And 
on a still deeper level this fear is an expression of pregenital fantasies of incor- 
poration, bacilli being the equivalent of introjected objects with a destructive 
(and destructible) character (1459). The interrelationship of sadism and mas- 
oschism can easily be reflected in ideas of infection because it is equally possible 
to be infected by other persons and to infect them. 

The idea of infection also lends itself to a rationalization of feelings connected 
with the archaic taboo of touching. In magical thinking, the characteristics of 
any object are thought of as material substances which may be communicated 
by touch in the same way as dirt or germs are communicated. The archaic fear 
of touching may vary in instinctual content. Freud called attention to the fact 
that there is no impulse whose goal would not involve the touching of an object, 
whether this drive aims at a hostile, a sensual, or a tender approach to another 
person, or at an autoerotic touching of one’s own body (618), and all these im- 
pulses may be phobically feared. Frequently the objects that must not be touched 
show at first glance their character as genital symbols. These persons interpreted 



210 the psychoanalytic theory of neurosis 

the prohibition of infantile masturbation, which frequently takes the form of 
‘‘don’t touch,” as if it were literally merely a prohibition of touching, or they in- 
terpreted it in this way in “spiteful obedience ” They may develop types of 
masturbation in which they avoid the touching of their genitals with their hands 
(1262). Not infrequently a wish to masturbate that has been warded ofl has been 
altered by regression, so that the phobia appears to be a protection against anal- 
erotic wishes to be dirty or to soil. Occasionally this is immediately apparent: 
things that are believed to be dirty, such as doorknobs, or things that come in con- 
tact with the water closet must not be touched; or the prohibition may concern 
things that are used for cleaning the body {see pp. 288 f.) . 

Cases in which the anxiety changes from a fear of impending infection to the 
idea of having been infected may represent transitional stages, in which a phobic 
idea is in process of becoming a delusion. Ideas of this sort may be hypochondria- 
cal in nature, such as notions of being devoured by bacteria or cancer cells, or of 
being poisoned (948). However, apprehensions of this sort are also met with 
in pure anxiety hysterias, where they correspond to unconscious conflicts over 
castration or impregnation. 


FURTHER DEVELOPMENT OF ANXIETY HYSTERIAS 

Most often the outbreak of an anxiety hysteria is followed by the develop- 
ment of a phobia, that is, of an avoidance of the situation or of the perceptions that 
produce the anxiety. Sometimes the anxiety can in fact be avoided by the de- 
velopment of an appropriate phobia, at the cost of a certain limitation of the 
ego’s freedom. The illness can be brought to a standstill, the instinctual danger 
has been completely and successfully turned into a, perceptual danger. 

However, in other cases the development is not favorable. In the first stages, 
the neurosis may be complicated by a secondary traumatic neurosis, induced by 
the first anxiety spell which is experienced as a trauma (1569). Many anxiety 
hysterias develop, out of such an experience, a fear of anxiety, and simultaneously 
a readiness to become frightened very easily, which may create a vicious circle. 
Some phobias do not succeed in their attempts at projection and develop progres- 
sively; the projection becomes inadequate and the phobic conditions increase in 
scope. For example, a patient may at first not be able to walk across a certain 
square, later on he cannot go out of doors, and finally, perhaps, not even out of 
his room. The elimination of external situations has not diminished the effective- 
ness of the drives that were stirred up by the avoided situation. The impulses 
continue to operate. The fact that they do not find an outlet makes them still 
more intense, and this necessitates the extension of the phobia (590), Whether 
or not the projection succeeds depends on the economic equilibrium between 



ANXIETY AS NEUROTIC SYMPTOM! ANXIETY HYSTERIA 

impulses and opposing anxiety; and that means on the whole previous history 
of the personality (see pp. 551 £f.). 

The projection of one’s own excitement may sometimes succeed in the sense 
that a patient gets rid of certain anxieties, restlessness, and kinesthetic sensations 
if certain conditions are fulfilled which represent a projection of these features. 
If a patient can feel some external anxiety, restlessness, noise, confusion around 
him, he may get rid of the anxiety, restlessness, noise, and confusion within. 
There are not only persons who have a thunderstorm phobia (which means 
those who have projected their sensations onto the thunderstorm, and who thus 
have externalized but not overcome their anxiety), but there are also persons 
who enjoy thunderstorms, because becoming aware of the external noise enables 
them to achieve the aim of their projection: the actual noise outside makes them 
feel that there is no noise inside any more, and that therefore they no longer 
need to be afraid. 

Certain persons state that they need ‘‘stimulation” or “distraction” to work at 
their best. They have neurotic disturbances of concentration. Their work is dis- 
turbed by inner tensions which make themselves felt as restlessness. However, 
they can overcome the disturbing feelings by* seeking surroundings that provide 
external restlessness. 

The sociological role of the so-called Cafehaus in certain parts of Europe (or of 
the club in other countries) is certainly complicated and cannot be explained by 
a simple psychological formula. The following case history may be significant in 
this respect. 

A patient was an excellent worker in the Cafehaus — and he preferred the 
noisy ones, with music playing and many people around — but was unable to 
work in his study at home, where he was alone and everything was quiet. It is 
true this man found certain instinctual satisfactions in the cafe (especially scopto- 
philic and homosexual ones); but that was not particularly important. The fact 
that he felt he had to run away when it was quiet, but was able to become relaxed 
and quiet when people were making noise around him, was of greater impor- 
tance (444). 

It would be worth while to study which types of personality, when neurotically 
disturbed in their concentration, need absolute quiet around them and which 
types require the opposite. Probably it will turn out again that there are not 
two opposite types but that the need for external quiet or noise has again a 
double-edged character. What is comfortable and relaxing up to a certain degree 
of intensity may suddenly become unpleasant and frightening beyond this in- 
tensity. That persons can get rid of their anxieties by reassuring themselves that 
they are able to frighten others is simple enough (541, 784, 895, 971, 1298). But 
sometimes this simple mechanism is complicated by a successful projection of 
the kind under discussion here; persons with anxieties create an atmosphere of 



212 XHE PSYCHOANALYTIC THEORY OF NEUROSIS 

anxiety around them, and feel better if this anxiety is outside themselves. This 
also may have a double-edged character: if they succeed too well, and discover 
that everyone around them is really frightened, they may feel that they have 
destroyed their potential protection, are endangered by retaliation, and suddenly 
become extremely frightened themselves. 

If often happens that individuals with phobias cannot succeed in avoiding the 
feared situations. Again and again they are forced to experience the very things 
they are afraid of. Often the conclusion is unavoidable that this is due to an un- 
conscious arrangement of theirs. It seems that unconsciously they are striving 
for the very thing of which they are consciously afraid. This is understandable 
because the feared situations originally were instinctual aims. It is a kind of “re- 
turn of the repressed out of the repression.” The urge of die original drives, 
which are still effective, is also the basis for all attempts to overcompensate pho- 
bias by counterphobic attitudes (435)? by a preference for situations originally 
feared (see p. 480) . 

Phobias, that is, the avoidance of situations that create anxiety, are not the 
only means by which the ego tries to cope with anxiety. Other methods of de- 
fense against anxiety, like the sexilalization of anxiety, intimidation of others, 
identification with the frightening objects, collection of external reassurances 
are also used in anxiety hysteria (see pp. 479 if.) . 

THE REPRESSING FORCES AND THE REPRESSED IN THE SYMPTOMS OF 
, ANXIETY HYSTERIA 

Any psychoneurotic elaboration of the consequences of the state of being 
dammed up results in a compromise between the conflicting forces. As a rule, 
this compromise consists of a substitutive and* therefore painful discharge of a 
derivative to which a part of the cathexis of the repressed had been displaced; but 
the discharge of the derivative facilitates (or at least does not impede) the ward- 
ing off of the remaining original impulse. At first glance, an anxiety spell seems, 
like a state of inhibition, a pure manifestation of the defending forces which 
give their danger signal when temptation or punishment approaches. However, 
the anxiety spells have the character of an emergency discharge also. The dis- 
placements in anxiety hysteria doubtlessly created substitutes for the impulse 
originally warded off, thereby facilitating the original defense. Thus anxiety in 
anxiety hysteria actually is more than a manifestation of the defending forces. It 
is a psychoneurotic symptom, although the unconscious anxiety motivating the 
defense still finds its expression as such. 

If other psychoneurotic symptoms not connected with manifest anxiety are 
artificially suppressed, manifest anxiety, as a rule, makes its appearance. This 
shows that anxiety hysteria is relatively more primitive than other psychoneu- 



ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTERIA ^13 

roses. The neurotic symptoms without anxiety are more complicated elaborations 
in which the person has learned to avoid or to bind anxiety (618). 


ANXIETY HYSTERIA IN SMALL CHILDREN 

The primitive character of anxiety hysteria is also expressed in the fact that 
anxiety hysteria is the typical neurosis of childhood (cf, 175)* To some extent, 
symptoms of anxiety hysteria seem to be regular incidents in the normal devel- 
opment of any child, at least under present cultural conditions. There is hardly 
a child who has not at some time been afraid of being alone or of the dark or of 
animals. Fear of the dark may be reduced to the fear of being alone. Freud 
quotes a child who was afraid of the dark as saying: “If someone talks, it gets 
lighter” (596). 

To be left alone is an objective danger for the helpless child. However, the 
child actually is not afraid of objective dangers, which he is not able to judge. 
(Many worries connected with child rearing would become superfluous if chil- 
dren were able to judge real dangers adequately.) What the child fears is much 
more the possibility of a “traumatic situation,” of being overwhelmed by excita- 
tion. It is not the objective helplessness of the child that creates his anxieties but 
his helplessness in the face of his drives which he is unable to discharge without 
the help of other persons. Besides, the disappearance of a loved person also pre- 
vents any expression of his love, and thus creates a state of being dammed up. 
It appears, as Freud said, as if the child were not yet able to manage the longing 
for absent beloved ones in any better way than by letting it be transformed into 
anxiety (596). 

The relationship of anxiety to the instinctual conflicts is more obvious in the 
animal phobias. The child is not as arrogant as the adult person, who tries to 
believe in a fundamental difference between human beings and animals. A child 
can easily imagine human beings in the form of animals (579), and the animals 
feared in the phobias are as a rule distorted representations of human beings, 
usually of the father. The representation of the father as an animal signifies the 
sexually excited father. It expresses the perception of the father as animal- 
like, that is, as a passionate, sexual, or aggressive being- This frightening aspect 
of the father may sometimes express his punishing (castrating) force, as in the 
case of little Hans (566), and at other times the frightening aspects of the sexual 
demands directed toward him, as in the case of the wolf-man (599)* 

The case described by Helene Deutsch, which was mentioned before (327), 
shows that not all animal phobias arc constructed in that way. The animal does 
not necessarily represent the feared parent. It may be a direct projection of one’s 
own drives. 

Likewise small animals such as insects, spiders, flies, and so on, which are often 



214 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

feared in phobias, do not represent the father. A spider may sometimes mean 
“the cruel mother” (23), but more frequently creatures of this kind are either 
symbols of genitals or feces, or of little children (brothers and sisters) (552), de- 
pending upon the unconscious equation child = feces (593). A patient whose con- 
flicts centered around her hatred for her younger brother was afraid of all insects 
and believed, in her retaliation fear, that all insects are poisonous. 

Some of the early anxiety hysterias find a spontaneous cure after a certain 
time. It is as if the children simply grow out of them. (Others do not have this 
favorable outcome; they form the basis of later neuroses in adult life.) This is 
made possible by two circumstances: (i) The ego of the child is still developing; 
the early anxieties are due to the incapacity to achieve active discharges; when 
the ego becomes stronger it becomes able to master its excitation with the help of 
its increased mastery of motility. (2) Where fear over loss of love was the reason 
for warding off certain impulses, increased experience and confidence may con- 
vince the child that such a danger does not exist, and the warding off becomes 
superfluous (see pp. 547 f.). 

THE PRIMAL SCENE 

It is not possible to discuss anxiety in children without mentioning anew the 
so-called primal scene, that is, the observation of sexual scenes between adults, 
especially between the parents (599). 

Such an event creates a state of great excitement in a child. This excitement, 
not being produced spontaneously by the child but brought to it by external 
stimuli, goes beyond the capacity for mastery as yet developed. The scene, there- 
fore, is likely to produce a “traumatic state” by flooding the organism with an 
inappropriate excitation. Thus such an experience is likely to connect the ideas 
of sexual excitation and danger. This connection may be further increased by 
misinterpretations of what is perceived (misinterpretations which, in turn, may 
be due partly to the fact that the child is in a “traumatic state” — ^but also, partly, 
simply to ignorance and animism). The most frequent types of misinterpretation 
are the interpretation of sexual intercourse as a cruel, destructive act, and the 
interpretation of the female genitals as a result of castration. 

The psychic content of the aroused excitement and its intensity vary according 
to the child’s age and previous history. Individual factors will determine what 
the child perceives, how he interprets his perceptions, what mental connections 
arc established, and whether interpretations and the mental connections are 
made immediately or later: for example, identification with the parent of the 
same sex or with the other parent, fixation on the state of libido organization 
that prevails at the time, or special coloring of the Oedipus complex. But what 
is always present is the linking together of the conceptions “sexual satisfaction” 
and “danger,” which creates a disposition for subsequent neurosis. 



ANXIETY AS NEUROTIC SYMPTOM: ANXIETY HYSTERIA 215 


It has been mentioned that certain uncanny experiences of sensations of equi- 
librium and space may be the remnants of infantile sexuality. In psychoanalytic 
practice, we have the habit of stating, when sensations of this kind come up, 
such as unclear rotating objects, rhythmically approaching and receding objects, 
sensations of crescendo and decrescendo, that “primal-scene material is ap- 
proaching.” Practically, that is true. But of course sensations of this kind are 
not specific for “becoming aware of sexual scenes in the surroundings.” They 
are, rather, specific for being overwhelmed by excitation. 

It is well known that while falling asleep the inhibiting forces decrease before 
the drives do, and that, therefore, in this state the temptation to masturbate is 
most intense. In falling asleep, also, archaic types of ego feelings are regressively 
experienced before consciousness is lost and a high percentage of these “archaic 
ego feelings” are felt as sensations of equilibrium and space. A normal person 
is not bothered much by these sensations. He may even not be aware of them, 
unless he expressly directs his attention to them (837). This is different in per- 
sons whose infantile masturbation is represented by these sensations, and these 
again are mainly persons who have had primal-scene experiences. A minority 
of these persons may still enjoy such sensations as a kind of masturbation equiva- 
lent. The majority, after repression, are afraid of them, and in extreme cases such 
fears may become the cause of severe sleep disturbances. 

Thus it is understandable that a marked tendency toward anxiety dreams and 
pavor nocturnus frequently follows a primal scene or an “equivalent” of a primal 
scene (7, 1166). 


THERAPEUTIC PSYCHOANALYSIS IN ANXIETY HYSTERIA 

In general, anxiety hysteria presents a definite indication for psychoanalysis, 
and only in the presence of some special contraindication should one advise 
against analysis. The capacity for transference is excellent. However, cases ex- 
hibiting compulsive symptoms and based more on pregenital and aggressive 
conflicts are less favorable. Freud has called attention to a modification in tech- 
nique necessary in analyzing typical phobias. After the framework of the 
neurosis has been loosened enough by the analysis, the analyst must actively inter- 
vene in order to induce the patient to make his first effort to overcome the pho- 
bia; he must induce the patient to expose himself to the feared experiences for 
the purpose of bringing the full force of the neurodc conflict into the open (600). 



Chapter XII 
CONVERSION 


WHAT IS CONVERSION? 

Ik CONVERSION, symptomatic changes of physical functions occur which, uncon- 
sciously and in a distorted form, give expression to instinctual impulses that pre- 
viously had been repressed. 

Any neurotic symptom is a substitute for an instinctual satisfaction; since ex- 
citement and satisfaction are phenomena that express themselves in a physical 
way, the leap into the physical sphere, characteristic for conversion, is in prin- 
ciple not so strange. However, conversion symptoms are not simply somatic 
expressions of affects but very specific representations of thoughts which can 
be retranslated from their “somatic language” into the original word language 
(543>55o)' 

The problem of conversion symptoms can be approached by a comparison 
with spells of affect. These, as was previously stated, occur when an intense 
stimulus (or a normal stimulus when a state of being dammed up exists) tem- 
porarily overthrows the ego’s mastery of motility, and an archaic discharge syn- 
drome replaces purposeful actions (and such syndromes subsequently may be 
tamed and used by the re-established ego). Conversion symptoms, too, are char- 
acterized by a sudden overwhelming of the ego’s mastery of motility and by in- 
voluntary physical discharge syndromes. The difference, however, is that in 
normal afiects the syndromes that supplant action are similar in every human 
being; we do not know where they originated, and revert to phylogenetic specu- 
lations for an explanation. The syndromes of conversion symptoms are unique 
in every individual, and analysis shows where they originate: they are histori- 
cally determined by repressed experiences in the individual’s past. They repre- 
sent a distorted expression of repressed instinctual demands, the specific type 
of the distortion being determined by the historical events that created the re- 
pression. 

PREREQUISITES FOR THE DEVELOPMENT OF CONVERSIONS 

There arc two prerequisites for the development of conversions, one of a physi- 
cal, the other one of a psychological nature. The physical prerequisite is the 
general crogeneity of the human body, which makes it possible for every organ 
and every function to express sexual excitement. The psychological prerequisite 
is a prior turning from reality to fantasy, a replacement of real sexual objects by 
fantasy representatives of infantile objects; this process is called introversion. 



CONVERSION 


217 


It will be recalled that after the establishment of thinking as a testing action 
two types of thinking can be distinguished, one that prepares for action and one 
that substitutes for action. The first one is logical and verbalized, and functions 
according to the reality principle; the second is archaic, pictorial, magical, and 
functions according to the pleasure principle. Daydreams represent the second 
type of thinking; they are a pleasant substitute for a painful reality. Very often, 
daydreams find connections to repressed demands, become overcathected by 
displacement from the repressed and in this way become derivatives of the re- 
pressed (564). 

In their introversion, hysterics have regressed from a disappointing reality to 
the magical thinking of daydreaming. This may be conscious as long as the day- 
dreams remain far enough from the repressed contents, especially from the 
objectionable Oedipus complex, but if they come too close, they, too, will be re- 
pressed (see p. 193), They then return from the repression, distorted as conver- 
sion symptoms. 

Due to the introversion, hysterical individuals appear to be turned inward. 
Their symptoms, instead of presenting actions directed outward (alloplastic 
activities), are mere internal innervations (autoplastic activities). In other words, 
the fantasies of hysterical individuals, after having been repressed, find plastic 
expression in alterations of physical functions. In this connection Ferenczi spoke 
of “hysterical materialization” of the fantasies (486, 489). Hysterics, when “ma- 
terializing,” only exaggerate something that likewise appears in normal fantasy, 
indeed in all thinking. Thinking, replacing action, is still a bit of action; the 
innervations of the actions that are thought of take place during the thinking, 
only to a lesser degree (482). It is this “bit of action” that is especially marked 
in introverted hysterics and that forms the basis of the innervations constituting 
the conversion symptoms, 

HYSTERICAL SPELLS 

The aforementioned possibility of retranslating conversion symptoms from 
their somatic language into the original word language is best demonstrable in 
major hysterical spells, which have become rare nowadays. These spells are 
pantomimic expressions of sometimes rather complicated fantasy stories (565, 
1620). They can be analyzed in every detail, in the same way as dreams, and 
they use the same distortion mechanisms as dreams. 

It is worth while to recall what these distortion mechanisms consist of: con- 
densation, displacement, representation by the opposite, exaggeration of details 
that represent the whole, reversal of the sequence of events, multiple identification, 
symbolism, and suitability for plastic representation (552). 

If the “latent seizure thoughts” arc analyzed (as “latent dream thoughts” are 
analyzed from a manifest dream) it turns out that they represent a mixture of 



2i8 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


elements of forgotten events and of fantastic dream stories constructed around 
the events (550, 1620). They represent distorted expressions of the Oedipus 
complex and of derivatives of the Oedipus complex. Sometimes the spells clearly 
betray that they stand for a sexual gratification and they may terminate in states 
resembling orgasm. Freud compared the loss of consciousness at the height of 
the attack to the momentary loss of consciousness at the height of orgasm (565). 
In other cases the spell does not connote fantasies directly concerning intercourse 
or seduction; instead the daydreams are focused rather around some aspect of 
pregnancy or childbirth. The classical example is seen in the well-knowm cases of 
hysterical pseudo pregnancy (150, 804); but many a hysterical vomiting is also of 
this nature. The seizure may likewise express sexual sensations characteristic for 
a person of the opposite sex with whom the patient has identified (562) . 

At the height of her fits, a woman patient used to have jerking convulsions in 
her arms. Analysis revealed that they portrayed the spasmodic contractions of 
the penis during ejaculation. A similar significance became evident in the sneez- 
ing spells of a hysterical woman patient; her nose represented her fantasied penis. 

The seizure may also express pregenital actions which have become substi- 
tutes for the original Oedipus ideas. 

Not all hysterical spells occur in the form of specific pantomimic actions or 
movements which give the analyst direct hints as to the past situation or day- 
dream of which they form a part. .Sometimes the manifestations of a spell are 
much less specific and occur either in the form of convulsions {see “motor dis- 
turbances,” pp. 223 ff.), of exaggerated or apparently entirely unmotivated emo- 
tions or “moods,” or as screaming, crying, or laughing spells (1464). 

Spells of this kind, too, are the emotional climaxes of complicated unconscious 
fantasies. The screaming, crying, laughing, then, are comparable to emotions felt 
on awakening from a dream, although the dream itself has been forgotten. The 
manifest emotion permits a few general conclusions about the emotional nature 
of the latent thoughts but nothing more can be said about it unless the latent 
thoughts are analyzed. Hysterical screaming, for example, may be the expression 
of very different emotions. Sometimes the type of screaming alone gives a hint. 

It may be an infantile screaming for help (1419), it may be an expression of the 
helplessness (and the joy) of a woman sexually attacked, it may belong to dreams 
about childbirth, or it may be an expression of rage; it may also mean an enuncia- 
tion of “masculinity.” The laughing in laughing spells frequently expresses tri- 
umph because of the fantastic fulfillment of hostile wishes (436), especially of 
revenge ideas arising from the revenge type of the female castration complex (20); 
however, the laughing may also simply be a pars-pro-toto distortion of sexual 
excitement, in the way in which children often express any type of excitement by 
obsessive and exaggerated laughing. Hysterical crying frequendy corresponds to 
a displacement upward” of conflicts around sexualized urination (428, 1055). 



CONVERSION 


219 


Related to seizures are those conversion symptoms that consist in a patho- 
logical appearance or disappearance of normal physical needs, like attacks of 
hunger or thirst, a need to defecate or urinate (759), or a sudden lack of appetite 
or thirst, constipation or oliguresis (1577), or difficulties in breathing. All these 
conversion symptoms are rooted in periods of infantile sexuality when other 
physical functions were still in the service of pleasure seeking, which permits the 
physical symptoms to lend themselves to the expression of sexual fantasies. Hun- 
ger, thirst, and excretory needs may supplant sexual longing; anorexia — a denial 
of sexual longing; constipation, or oliguresis may express retentive tendencies 
connected with pregnancy wishes or incorporation fantasies (frequently occur- 
ring in accordance with the equation child = penis = feces) (593, 832) ; vomiting 
and diarrhea may express resistance to both pregnancy wishes and incorporation 
fantasies. 

MONOSYMPTOMATIC CONVERSIONS 

The historical basis of conversion symptoms is often very clear in monosymp- 
tomatic conversion symptoms. Instead of a memory, an innervation occurs, 
which had actually taken place in the forgotten situation. Breuer s first patient, 
Anna 0 , had a paralysis of her arm whenever she was unconsciously reminded 
of her feelings toward her father. At the time her father died, she had been sit- 
ting at his bedside with her arm pressed against the chair at the side of the bed 
(188). 

It is misleading to call monosymptomatic hysterias organ neuroses, because 
this expression should be reserved for another type of neurosis (see pp. 236 ff.) ; but 
nevertheless it is frequently done. For example, so-called cardiac neuroses are 
often really monosymptomatic conversion hysterias, the cardiac symptoms ex- 
pressing sexual excitement, anxiety, or both, connected with specific uncon- 
scious daydreams. 

The monosymptomatic hysterias frequently demonstrate Ferenczi’s concep- 
tions of hysterical “materialization” and “genitalization” (489). Repressed 
thoughts find their substitute expression in a material change of physical func- 
tions, and the afflicted organ unconsciously is used as a substitute for the geni- 
tals. This “genitalization” may consist of objective changes within the tissues, 
for example, hyperemia and swelling, representing erection; or it may be limited 
to abnormal sensations imitating genital sensations. The so-called stigmata be- 
long to this category (487, 1167). 

A patient suffering from a cardiac neurosis related that the continual palpita- 
tion of his heart was accompanied by the feeling that his heart was getting larger 
and larger, that his whole chest was becoming more and more tense, up to a 
certain almost unbearable point, and that then the whole process would stop, the 



220 the psychoanalytic theory of neurosis 

palpitation would cease, and his heart would shrink again. These sensations 
represented an increasing erection, finally ending with orgasm. 

A few days after this interpretation was given, the patient reported that a new 
symptom had set in. He now felt as if his heart were breaking open in order to 
take something in. Thus the “genitalization’ of the heart in this case had a bi- 
sexual significance: it represented the masculine as well as the feminine genitals. 


HYSTERICAL PAINS AND HYSTERICAL IDENTIFICATION 

Conversion symptoms are intermittent or continuous discharge processes that 
appear in place of inhibited infantile sexual impulses with which they are con- 
nected by unconscious associations. A first type of hysterical pain, Freud states, 
“was really present in the situation when the repression took place” (618). In 
cases in which the original physical pain was experienced by the patient himself, 
the repetition of the pain in the conversion symptom is a substitute for a desired 
pleasant excitement which had somehow become connected with it; the pain 
is now simultaneously a warning signal not to yield to those pleasant sensations. 

A patient suffered from pain in the lower abdomen. The pain repeated sensa- 
tions she had felt as a child during an attack of appendicitis. At that time she had 
been treated with unusual tenderness by her father. The abdominal pain expressed 
simultaneously a longing for the father’s tenderness and a fear that an even more 
painful operation might follow a fulfillment of this longing. 

Childhood diseases are often very impressive episodes in the development of 
instinctual conflicts in a child, sometimes in the nature of satisfactions (gaining 
more love or other types of love from the parents^ or experiencing the body in a 
new way), oftener in the nature of threats (the disease may be perceived as cas- 
tration or, generally, as a punitive consequence for previous masturbation or 
other instinctual behavior). Sensations experienced in fever are very apt to sig- 
nify the sensations of a feared instinctual excitement, pleasurable up to a certain 
degree, painful and frightening beyond it. Subsequent conversion symptoms, in 
repeating pains of childhood diseases, mean the repetition of the instinctual con- 
flicts developed or mobilized by these diseases. In other cases the associative con- 
nection between the instinctual conflict and the disease that is initiated may be 
a more superficial one. The special form of a conversion symptom that imitates 
a past sickness may be a mere time signal showing that a symptom alludes to 
an impulse from the time of this sickness. 

In general, the formulation holds: whenever a functional disturbance has be- 
come associated with an emotional conflict , in childhood and this conflict has 
been repressed, any subsequent allusion either to the functional disturbance or 
to the emotional conflict is apt to mobilize both components of the whole syn- 
drome, the functional disturbance becoming the conscious manifestation, the 



CONVERSION 


221 


emotional conflict the unconscious driving force of conversion symptoms (313, 
316). 

In a second type of hysterical pain, the original feelings that are imitated in 
the conversion symptom may, however, have been experienced not by the patient 
but by another person whom the patient imitates by producing his symptom. 
Hysteria, as is well known, may imitate any and every disease, a circumstance 
that makes the clinical picture of conversion hysteria so very multiform. This 
“hysterical identification” which expresses the wish to be in the place of another 
person needs further comment. 

Identification is the very first type of reaction to an object. All later object re- 
lationships may under certain circumstances regress to identification. The hys- 
terical identification is characterized by the fact that it does not involve the full 
amount of cathexis available (408). There are several variations of identifications 
of this kind. 

1. The simplest case is the “hysterical identification with the fortunate rival,” 
that is, with a person whom the patient envies and whose place he had wished 
to occupy from the beginning. Freud’s patient Dora developed a cough like that 
of Mrs. K, whom she unconsciously perceived as a rival. Dora envied Mrs. K’s 
sexual experiences; because of her guilt feelings about this rivalry she could not 
put herself in Mrs. K’s position, in the place she would have liked, but had to 
select Mrs. K’s affliction as the point of identification (557). This identification 
by way of her sense of guilt replaced the intended identification in instinctual 
experiences. It is as with King Midas, who was so greedy for gold. His wish was 
granted, but in such a way that he was destroyed by his gold. 

The mechanism of Midas’ punishment can frequently be observed in all types 
of neuroses, in compulsion neuroses perhaps still more frequendy than in hys- 
terias. Obsessions may express the idea: “You shall get what you wished for, but 
in a way, to a degree, or at a time where it shall destroy you.” In symptoms of 
this kind there are various layers of drive and defense condensed with one an- 
other, and it is not easy to distinguish between the instinctive impulse returning 
from repression and the tendency of the superego which caricatures the instinctive 
impulse for punitive purposes. ^ 

2. It sometimes happens that a woman whose hysteria is due to her Oedipus 
complex makes an identification not with her rival, her mother, but with her 
beloved father. This is a more complicated situation. Whenever a person is 
forced to relinquish an object, he may develop a tendency to compensate for 
the loss by identifying himself with the object (608). When a hysterical woman 
takes over her father’s illness, she shows that she is vainly attempting to free her- 
self from him. 

A patient’s hysteria imitated tuberculosis. Her father, as a young man, had 



222 the psychoanalytic theory of neurosis 

been affected by this illness. She had furthermore taken up the same profession 
as her father, and was very close to manifest homosexuality. 

An identification of this sort at the same time furnishes an opportunity for the 
gratification of the negative Oedipus complex (562). 

3. The most frequent form of hysterical identification takes place with an 
object toward whom the patient has no genuine object relationship. It is formed 
“on the basis of identical etiological needs.” Freud used a hysterical epidemic 
in a girls’ school as an example. A girl reacts with a fainting spell to a love letter, 
and then the other girls also get fainting spells. The unconscious meaning is: 
“We should like to get love letters, too” (606). The object of the identification 
has no other significance than that she got a gratification for which the subject 
had likewise longed. Again, the fact that painful experiences are produced is 
an expression of the repressing forces, a kind of Midas wish fulfillment: “You 
wanted to be as happy as X? Well, just for that, here is the punishment she got!” 

Identification on the basis of identical etiological needs, being temporary in 
character and performed with an object toward whom there is no other rela- 
tionship, affords an opportunity to discuss the relationship between identifica- 
tion and imitation. This mechanism looks like a simple imitation; it is, however, 
unconscious. Any imitation, whether conscious or unconscious, presupposes a 
kind of identification, that is, an alteration of one’s own ego which follows the 
pattern of an object model. However, the identification at the basis of imitation, 
as contrasted to other types of identification, is a superficial, limited, capricious 
one, employed for one definite purpose only. This purpose may or may not be 
conscious. Unconsciously, anyone may be imitated who as a prototype seems to 
promise some libido-economic advantage, some possibility of finding relief from 
internal conflicts. Related to this is the phenomenon of the infectiousness of 
slips and errors (1285, ^5^4)- 

4. There are also “multiple identifications,” especially in seizures, A hysterical 
patient may simultaneously or serially play the part of various persons with 
whom she has identified herself, according to any of the described types. The 
seizures of such patients very often represent the enactment of a whole drama. 

The classical example for this is Freud’s patient who tried to take her clothes 
off with her right hand while making an effort to keep them on by grasping them 
with her left. She was identifying herself simultaneously with a man raping and 
a woman being attacked (562; cf» also 471). 

A climax of multiple identifications is shown by the famous case of “multiple 
personality” (1065, 1586). 

Hysterical identifications may even take place with a pain actually never ex- 
perienced by the model for identification, but only in the fantasy of the hysteric. 

One day a patient felt an intense pain in her finger. She stated that she felt as 
if she had cut her finger with a knife. She was in love with a cousin, a medical 



CONVERSION 


223 


student, who did not live in the same city. She fantasied that perhaps, just at the 
moment she felt the pain, he might have cut himself while dissecting. This 
fantasy, giving the pleasure of a magical connection with the loved one, was a 
conscious daydream. The unconscious continuation of this daydream was the 
symbolic equation \nife = penis and cutting = coitus. The analysis also revealed 
very clearly that the cousin was a substitute for the father, while her identification 
with a corpse led to specific infantile sexual theories. 

In a certain sense it is even possible to speak of “hysterical identifications with 
oneself,” namely, with a past ego state (387) . Many conversion symptoms have 
the significance of a regression into that period of childhood when the repression 
occurred, the maintenance of which is now endangered. 

In some hysterical pains the repetition of past actual (or imagined) pains is 
less impressive than an anticipation of desired events or of a prospective punish- 
ment for them. The pains may be a part of unconscious sexual fantasies. They 
may express the idea of being raped; some abdominal pains and even some head- 
aches express the idea of being pregnant. Such painful illustrations of day- 
dreams, however, are not necessarily opposed to the hysterical pains hitherto de- 
scribed. They illustrate the feared and hoped-for future by meanstof remobilizing 
related actual experiences of the past. 


HYSTERICAL HALLUCINATIONS 

Hysterical hallucinations “Were perceptions at the time of the repression” 
(618). 

A patient suffered from the torturing hallucination of a metallic taste in her 
mouth. It turned out that as a child she had been accustomed to drink by put- 
ting her mouth directly to the faucet. At that time what was now being hallu- 
cinated had been an actual perception. The childhood practice was a cover for 
unconscious wishes to perform fellatio. 

Olfactory hallucinations, too, sometimes can be reduced to definite real percep- 
tions of the past which had some instinctual significance. This certainly does not 
contradict the fact that hallucinations of this kind simultaneously may express a 
phobia concerning body odor. There are also transitional states between hysterical 
and psychotic hdlucinations (just as between hysterical fears and delusions) 
{see p. 444). 

HYSTERICAL MOTOR DISTURBANCES 

“Motor paralysis is a defense against action” (618), namely, against an objec- 
tionable infantile sexual action. 

Hysterical paralysis is usually accompanied by an increase in tonus; this repre- 
sents both an insurance against the objectionable sexual action and a distorted 
substitute for it. Hysterical “masturbatory equivalents” often assume this guise. 
Historical circumstances and somatic compliance {see pp. f .) determine which 



224 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

particular part of the musculature is affected by the paralysis. Symptoms of this 
kind are said to appear more frequently on the left side of the body than on the 
right; this may be explained, as suggested by Ferenczi, by the idea that the left 
side of the body is in general more accessible to unconscious influences than the 
right, because right-handed persons have less conscious interest in it (489)- In 
addition the symbolic significance of right and left must be taken into account, 
right meaning correct and lejt meaning wrong (1479), sometimes, especially, 
right meaning heterosexual and left meaning homosexual (1463). 

Hysterical mutism is a special case of hysterical paralysis. It may express a hos- 
tility or an anxiety (a feared sexual temptation) toward the persons in whose pres- 
ence the symptom develops, a general lack of interest in the persons with whom 
talking would be possible (Dora became mutistic in the absence of the man she 
loved [557] ) 3 or it may mean death or castration. 

A spasm is a means of securing suppression of action, and simultaneously a 
tonic substitute for action. 

A spasm, limited to a certain part of the body, may represent erection; however, 
that is not necessarily the case. The muscular spasm may simply be the physical 
expression of repression. Hypertonus may be the representative of the general 
attitude “I have something to suppress.” 

In a woman patient who experienced a severe spasm of the pelvic floor during 
sexual intercourse this symptom was, first of all, a generalized vaginismus, en- 
suring her resistance to sexual experiences; it also represented hostile impulses 
toward her sexual partner and tendencies to protrude a fantasied hidden penis. 
Ferenezi has shown how a general “suppression spasm” may be created by a dis- 
placement of the function of the anal sphincters (a part of the pelvic floor) to the 
muscular system in general (505). 

Some hysterical spasms have the function of an assurance of a specific inhibition, 
They occur if an activity is intended that is prohibited by the superego, either 
because of its hidden sexual meaning or because, in the case of moral masochists, 
a forbidden success might be achieved by it. Of this type are writer’s and vio- 
linist’s cramp (867). 

The famous arc de cercle which has become rare nowadays represents, ac- 
cording to Freud, the innervations antagonistic to coitus, a representation by the 
opposite, expressing simultaneously the repressed desire and the repressing 
forces (565). Other writers have added that the symptom also gives expression 
to a masculine striving, an attempt to protrude a concealed penis (1564), as well 
as to a feminine one, the idea of childbirth (1025). 

Contracture is a displacing substitute for an intended but inhibited muscular 
innervation. It usually represcifts the tonic rigidity which is the result of a strug- 
gle between opposing impulses. 

Convulsions, too, represent affect equivalents or arc a pantomimic expression 
of a sexual, an aggressive, or a sexual-aggressive daydream. Sometimes hysteri- 



CONVERSION 225 

cal convulsions imitate organic convulsions that the patient had Avitnessed. The 
so-called hystero-epilepsy will be discussed later {see p. 267) . 


HYSTERICAL DREAM STATES AND DISTURBANCES OF CONSCIOUSNESS 

Hysterical dream states are closely related to seizures. As in seizures^ the day- 
dreams, which represent derivatives of the repressed, involuntarily take posses- 
sion of the personality, but here the pantomimic discharge is lacking. The day- 
dream, an outgrowth of Oedipus fantasies, breaks through as such, removing 
the patient from reality (3, 196). Sometimes the sexual meaning of this absence 
is directly apparent in a voluptuous pleasure the patient obtains from it. More 
often the affect, too, is repressed, and the new wave of repression against the 
mobilized derivatives keeps them so remote from awareness that the patient 
himself is unable to give any account of what he has experienced and is aware 
only of a gap in his consciousness (1015). 

A kind of mixture of hysterical spells and hysterical dream states is repre- 
sented by the conversion symptom of sleepwalking. The ‘‘dream state,*’ here, is 
a physiological one; sleepwalking occurs during normal night sleep; but a “pan- 
tomimic discharge” is achieved. This discharge sometimes only expresses the 
restlessness due to internal tension in an unspecific way. More frequently the 
discharge is a highly specific one. The movements of the sleepwalker are in re- 
sponse either to his manifest dream or to the latent conflicts at the basis of the 
dream. Sometimes running away from bed, which is felt as a place of tempta- 
tion, is in the foreground; more frequently the sleepwalking has a positive goal 
toward which the patient is striving: either a place of potential gratification of 
unconscious impulses or a place of effective reassurance against them or both 
simultaneously (711, 717, 1286, 1341, 1343). 

The typical aim of infantile sleepwalking is the wish to participate in the adults’ 
night life. The typical goal is the parents’ bedroom, signifying cither a place 
where sexual secrets may be witnessed or disturbed or a place where protection 
against nightmares and temptations is to be found, but usually both. If sleepwalk- 
ing is combined with loss of bladder control, this is not necessarily a proof of 
organic petit mal but may be a sign of the child’s unconscious sexual excitement. 
Sometimes sleepwalking expresses a tendency to run away from home. The old 
superstition of a connection between sleepwalking and moonlight is due partly to 
the emotional value of moonlight, which is simultaneously “light” and “dark- 
ness” and therefore suited to express unclear infantile conceptions of sexuality and 
sexual observations, and partly to the symbolic significance of the moon, 
moon * mother (430, 1322, 1579). 

It is not known what physical or mental circumstances make it possible to use 
the motor system during sleep, in contradiction to the general rule that, nor- 
mally, in the process’ of falling asleep the motor system is paralyzed first {595), 



226 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


but in accordance with the fact that in hypnotic sleep the motility is freely accessi- 
ble to hypnotic commands. 

Disturbances in consciousness generally correspond to the repression of a cur- 
rent derivative of infantile sexuality (1015, 1336). The transitory elimination of 
all consciousness is, so to speak, a generalized repression, probably the archaic 
pattern of all repression (410). The ideational content of the impulses entering 
dream states or causing disturbances of consciousness is as varied as the fantasies 
that produce hysterical symptoms in general. In the dream state, the transitory 
clouding of consciousness may not only express repression but may have an un- 
conscious significance of its own. It may {a) represent orgasm, {b) have the sig- 
nificance of death, which again may mean either death wishes against some 
other person turned against one’s own ego or have some unconscious libidinal 
meaning, or {c) serve as a blocking (and distorted expression) of hostile im- 
pulses of all kinds. This is especially true for hysterical spells of hypotonus and 
sudden fatigue, which may sometimes form transitional states toward organic 
narcolepsy. Disturbances of consciousness, because of their effect on the en- 
vironment, afford an opportunity for all sorts of secondary gains. In all hysterical 
dream states and disturbances of consciousness, the differential diagnosis of 
epileptic equivalents must be taken into consideration. 


HYSTERICAL DISTURBANCES OF THE SPECIAL SENSES 

Hysterical disturbances of special sensory perceptions represent elective “hys- 
terical disturbances of consciousness,” and what has been said about disturbances 
of consciousness in general holds true here, too. The disturbances of sensory per- 
ceptions represent the rejection of upsetting sexual perceptions. Inhibitions of 
this kind may extend from blindness or deafness, via negative hallucinations, to 
restricted limitations in the use of the senses, mentioned in the discussion of in- 
hibitions {see p. 177) . Symptoms of this kind sometimes start after a trauma as 
a posttraumatic ego inhibition (917), but soon get a hysterical “meaning” and 
arc retained as conversion symptoms. 

The restrictions of sensual perceptions are also a symptom of hysterical intro- 
version, that is, of a lack of interest in external events; this lack of interest in- 
creases the possibility of substituting fantasies for realities. 

Hysterical disturbances of vision were the subject of a very enlightening arti- 
cle by Freud (571). A hysterical “I cannot see” means “I do not want to see.” It 
indicates a repressed impulse to look (and to exhibit). From a punitive stand- 
point it' says: “Because you wish to see something forbidden, you shall not see 
at all” (367). A constriction of the visual field has often been described as char- 
acteristic for hysterics. Ferenezi explained it by the fact that peripheral vision has 
less significance for the ego, and is therefore more- readily sexualized (489) . 



CONVERSION 


227 


The sexualization of vision is not always due to simple scoptophilia or to the 
unconscious “genitalization” of the eye. The eye may also represent pregenital 
erogenous zones symbolically. As a sense organ it may express oral-incorporative 
and oral-sadistic longings in particular (430). Neurotic difficulties in reading 
usually are due to oral-sadistic conflicts (1512). 

A defense against oral-sadistic strivings is also the usual cause of another conver- 
sion symptom of vision: micropsia, that is, the phenomenon that objects appear as 
if seen through a reversed opera glass. Hallucinations and illusions of the sense of 
space seem generally to repeat experiences from. the earliest oral times (410), but 
in micropsia, this is especially evident. A patient of Inman’s experienced this 
symptom whenever her intense and frustrated oral longing was mobilized (831). 
A patient of Bartemeier’s had very early displaced an intense food envy onto her 
eyes; her micropsia expressed a tendency to push objects into the distance; this 
was an attempt to defend herself against the idea of killing objects by means of 
her eyes and a distorted return of this warded-off impulse (89). 


HYSTERICAL DISTURBANCES OF SENSATION 

Disturbances of sensation, in the same way as paralyses and sensual inhibitions, 
at first glance impress one more as a defense rather than as a return of the re- 
pressed. The elimination of sensation facilitates the suppression of memories 
that appertain to the body areas affected. However, they also serve the repressed 
impulses, for because of this very anesthesia, the anesthetic field may be used 
more by unconscious fantasies. Hysterical disturbances of sensation in general 
are repressions of internal perceptions in the same way that sensory disturbances 
are repressions of external ones (489) . 

Hysterical hypalgia is a kind of localized fainting; certain sensations that would 
be painful are not accepted. The basic mechanism probably is related to the 
archaic defense of “delay of affects” (see pp. 162 f.). 


SOMATIC COMPLIANCE 

In all these symptoms the entire cathexis of the objectionable impulses seems 
to be condensed into a definite physical function. The choice of the afflicted re- 
gion is determined by the following: 

I. By the unconscious sexual fantasies and the corresponding erogeneity of the 
afflicted part. A person with oral fixations will develop oral symptoms, a per- 
son with anal fixations anal ones; and fixations, for their part, depend on con- 
stitutional factors as well as on past experiences. However, the regression to 
fixation points in conversion symptoms is limited to the choice of the organ. 
What are expressed in a pregenital zone are genital fantasies; that is, nongenital 
organs are ‘*genitalized’* (489). It has been stated that chronic neurasthenics use 



228 the psychoanalytic theory of neurosis 

their genitals in a pregenital way {see p. 191); now it must be added that con- 
version hysterics use their pregenital zones in a genital way (565, 571). 

2. By purely physical facts. It is apparent that a symptom will more readily 
utilize an organ that presents a locus minoris resistentiae. Such a locus, again, 
may have been created by a constitutional weakness or by an acquired disease, ' 
An individual of strong vasomotor lability will be more subject to vasomotor 
symptoms; an organically myopic individual is more likely to produce eye symp- 
toms. 

This type of “somatic compliance” is certainly at work in the cases that are 
called “hysteric superstructure of organic diseases” (285, 1028, 1508). Organ- 
ically determined symptoms may simultaneously afford opportunity for the rise 
of a distorted expression of repressed impulses; that is, they may acquire a sec- 
ondary conversion meaning. They are not produced by conversion but they are 
used by conversion, and hence they may continue on a psychological basis after 
the organic cause that created them has ceased to exist. 

3. The choice of the organ may depend on the situation in which the decisive 
repression occurred. Those organs are likely to become the seat of disturbances 
that were most active or under the highest tension at the moment the decisive 
repression occurred (316, 532). 

4. Sometimes the choice of the afflicted organ seems rather to be determined 
by the ability of the function of the organ to express symbolically the uncon- 
scious drive in question. Incorporative tendencies can be better expressed by the 
mouth, the respiratory organs, and the skin, eliminatory tendencies by the in- 
testinal tract and also by the respiratory system. Convex organs like hand, foot, 
nose, breasts may symbolize the penis and represent masculine wishes; concave 
organs like mouth, anus, nostrils, flexing sides of extremities may symbolize the 
vagina and represent feminine wishes. 


ARCHAIC FEATURES IN CONVERSION 

Conversion symptoms are not limited to the voluntary muscular system but 
occur in the realm of the vegetative system as well. The urge to express uncon- 
scious sexual wishes in a distorted physical way has at its disposal a far more 
extensive area than has conscious will. As is well known, hypnotic commands 
have an influence over many more physical functions than normal conscious 
will; a concentrated training of constitutionally predisposed personalities may 
make these functions accessible to autosuggestive measures also (1410). The 
same functions are also made use of by conversion. Generally, the “archaic” ego 
controls more of the body functions than our adult ego does. The hysterical 
“hypcrfunctions” represent a regression to the archaic conditions that still ob- 



CONVERSION 


229 


tain in early childhood. Actually, the described characteristics of archaic motil- 
ity and perceptions {see pp. 36 fit. and 41 ff.) can be observed again in conversion 
hysterics. 

The insight into this regressive nature of the phenomenon of conversion may 
be taken as a starting point for speculations about the archaic origin of the capac- 
ity for autoplastic conversion. Lamarck’s theory of the evolution of species may 
be recalled, according to which evolution took place through the autoplastic 
adaptation of the body to the demands of the environment. A hysterical conver- 
sion may be a sort of last vestige of this primitive capacity of animals for auto- 
plastic adaptation. 

During normal development to adulthood certain capacities of the body are 
lost which become available again to the hysterical individual. Ferenczi once 
remarked that education is not only the acquisition of new faculties but also the 
forgetting of others, which, if not forgotten, would be called supernormal (489).^ 
This implies that the repression of autoeroticism also forces into repression some 
of the functions by means of which autoeroticism was effective. 

The “hysterical hyperfunctions,” as a return of the repressed, demonstrate the 
fact that hysterics by repressing their infantile sexuality repressed too much of 
their body functions. In hysterics the body is more or less “alien” to the conscious 
ego; they failed to identify their ego with their body. In the state of the “purified 
pleasure ego” (588) everything that was painful was regarded as nonego; those 
persons regarded their body as painful, and accordingly perceived it as nonego. 
They are inhibited both in respect to motility and sensibility. Persons who look 
upon their bodies as alien, when developing conversion symptoms with apparent 
“supernormal” physical capacities, are more readily able to repudiate the psy- 
chogenic nature of their symptoms. 

Although there is no full regression of the personality to pregenitality in con- 
version hysteria, nevertheless there is, especially in women, often a regression to 
the instinctual aims of incorporation. This is shown not only in the predominant 
role played by identification in conversion hysteria but also in more direct 
signs. The fellatio idea is extraordinarily common in the unconscious fan- 
tasies of hysterical women (globus hystericus). Analysis shows that this idea 
is a distorted expression for the wish to bite off and incorporate the penis. 
This fantasy is abundantly overdetermined. In individual cases the follow- 
ing meanings seem to be of different relative importance. It may mean {a) a 
displacement upward of genital wishes, {b) the idea of impregnation, (c) a re- 
venge on the man who possesses the envied organ, that is, an expression of active 
castrating tendencies, and {d) an incorporation of the castrated penis and an 
identification with the man (398, 407, 499). 

By this fantasy the sexual partner is deprived of his penis. For the hysterical 
woman the fantasy of genital union is so closely bound up with the Oedipus wish 



230 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


that she becomes incapable o£ real love. She can love, to quote Abraham, only 
if the genitals are excluded, because the genitals represent the objectionable 
part of love. The hysterical woman seeks to set up this condition when, in fantasy, 
she excludes the genitals by biting them off (26). 

An organ afflicted with a conversion symptom may also represent an object 
that has been introjected. However, in spite of such an incorporation the object 
still remains in the external world, too; hysterical introjection is a partial rather 
than a total regression from an object relationship to identification. 


GENERAL SIGNIFICANCE OF CONVERSION 

Conversion hysteria is the classical subject matter of psychoanalysis. As a mat- 
ter of fact the psychoanalytic method was discovered, tested, and perfected 
through the study of hysterical patients (187, 188, 542, 543, 544, 548); the tech- 
nique of psychoanalysis still remains most easily applicable to cases of hysteria, 
and it is psychoanalytic treatment of hysteria that continues to yield the best 
therapeutic results. 

The compromise character of the symptoms, which express the repressed forces 
as well as the repressing ones, and the dynamic relationship between instincts 
and counterinstinctual forces arc especially demonstrable in conversion. 

Some people blush at the slightest reference to a sexual subject. This is, first of 
all, certainly an expression of defense; simultaneously, however, it also betrays 
sexual excitement, the fact that the blushing individual responds to the sexual 
hint. The conversion symptom of habitual blushing as a rule expresses conflicts 
around exhibitionism (and around struggles for narcissistic supplies, sought by 
means of exhibitionism). 

In social gatherings which unconsciously represent sexual temptation, a patient 
regularly was seized with a need to defecate, which forced her to leave the room. 
She thus extricated herself from the disagreeable situation; but on the other hand, 
by her symptomatic act, she also showed, by regressing to an infantile expression 
of sexual excitement, that she had been stimulated. 

From the standpoint of the repressed impulse, the conversion symptom is the 
distorted substitute for sexual gratification on the part of the hysterical person 
who is incapable of genuine sexual gratification. The fact that the “substitute 
gratification” of the symptom is not felt consciously as pleasurable but is usually 
rather a severe suffering is due to the effectiveness of the repressing forces. Some- 
times this suffering can be regarded as a punishment inflicted upon oneself in 
order to undo guilt feelings (37). However, there are also symptoms that repre- 
sent instinctual gratification exclusively and have no punitive significance; 
symptoms of which the patient himself is unaware certainly cannot serve as 
a punishment. 

In conversion symptoms the countercathexis may manifest itself in various 



CONVERSION 


231 


ways. It may also be secondarily intruded upon by the returning original impulses 
in various ways. In cases of motor and sensory disturbances as well as in dis- 
turbances of consciousness, the inhibition of function is due to the counter- 
cathexis, but it also gives opportunity for the use of the inhibited function to 
express unconscious fantasies. In the case of hysterical pain, the attention directed 
to the protection of the painful organ, as a manifestation of the countercathexis, 
has replaced the original attention directed toward avoiding the tempting or 
threatening situation (618). The striving to rationalize all symptoms as 
“physical,” too, is a manifestation of the countercathexis. A kind of hysterical 
reaction formation is at work when an unconscious hatred is overcompensated 
in the form of an exaggerated consideration (618). 

OEDIPUS COMPLEX, MASTURBATION, AND PREGENITALITY IN 
CONVERSION SYMPTOMS 

Freud’s statement that the Oedipus complex is the nuclear complex of the 
neuroses is particularly valid in hysteria, which remains on the level of the 
phallic phase of sexual development. Hysterical individuals have either never 
overcome their early object choice or else were so fixated on it that after a dis- 
appointment in later life they again returned to it. Because all sexuality thereby 
comes to represent to them the infantile incestuous love, the urge to repress the 
Oedipus complex represses all sexuality. 

That hysteria occurs more frequently in women than in men is due to the 
fact that the sexual development of women is more complicated. The process of 
giving up the clitoris for the vagina may fail of completion. But not only Oedipus 
complex and “heterosexual identification” are characteristic for the structure of 
hysteria; inseparably connected with it are other characteristics, such as the 
particular means by which the Oedipus complex is suppressed. Frequently, chil- 
dren who have been allowed to become too intensely fixated on their parents are 
subsequently prohibited by those same parents in some particular manner from 
gratifying their Oedipus wishes. Among hysterical individuals, the type known 
as mother’s boy is frequently to be found, or women who seem to have no need 
of men, but inordinately admire their father. 

However, it would be erroneous to think that the ultimate content of the 
hysterical symptoms, the Oedipus complex, becomes immediately apparent under 
analysis. Between the Oedipus fantasies and the symptoms of the adult, the 
intermediate formations of daydreams are interpolated. And between the orig- 
inal Oedipus fantasies and the later daydreams there are inserted infantile mas- 
turbatory fantasies, whose Oedipus character is sometimes rather distorted. The 
conflicts which were originally connected with the Oedipus complex frequently 
are displaced onto the act of masturbation. That is why so frequently the strug- 



^3^ THE PSYCHOANALYTIC THEORY OF NEUROSIS 

gle against masturbation is found as the unconscious content of hysterical 
symptoms. Spasms, rhythmical muscular contractions, and sensory disturbances 
often proved to be simultaneous defenses against and substitutes for masturbatory 
activities (357, 550, 733). 

Daydreaming, which consciously may be designed to suppress masturbation, 
is mainly unconsciously an elaboration of the original masturbatory fantasies. 
Sometimes this secret relationship becomes manifest again under certain cir- 
cumstances in an unexpected manner (537). If the person succeeds in repressing 
the connections between the fantasies and the masturbation, the unrepressed 
fantasies, as unconscious equivalents of masturbation, sometimes develop into 
some exaggerated obsessive interests in certain fields. These interests are 
occasionally felt by the persons themselves as antimasturbatory measures, but 
betray themselves in analysis as offshoots of masturbatory fantasies connected 
with the Oedipus complex. The same holds true for certain habitual autoerotic 
games and symptomatic acts which give discharge to fantasies, in the main with- 
out the person being aware of them or at least of their importance for his mental 
equilibrium. 

The fantasies that intervene between the Oedipus complex and the hysterical 
symptom sometimes themselves are of a genital nature, for example, ideas of preg- 
nancy and childbirth. But this is by no means necessarily so. As intermediary 
links between the Oedipus wish and the apparently innocuous daydream, ideas 
are found originating in any erogenous zone and in any partial instinct. Al- 
though they are intermediary links only, they are certainly not unimportant 
from a practical point of view. Their discovery and working out may demand 
more time and attention in analysis than does the basic Oedipus complex, and 
the form the Oedipus complex itself has acquired as a result of the individual’s 
past infantile experiences can be elicited only through the careful analysis of 
these intermediary constructions (418). 

An example of intermediary oral fantasies: A patient complained of vomiting 
and nausea. In associating, she became aware that the symptom occurred when- 
ever she had eaten fish. Following this insight, she revealed several ideas dealing 
with the cruelty of eating animals. To eat fish seemed to her especially cruel, 
because fish had “souls” (the gut of a herring in German is called Seele, i.e., 
“soul”). The patient’s father was dead. The idea of eating his soul to make it part 
of her own body was a screen for the unconscious fantasy of sexual union with 
him. 

An example of a pregenital expression of predominantly genital wishes 
in a conversion symptom is presented by bedwetting, the most frequent mas- 
turbatory equivalent in children (91, 227, 263, 557, 667, 769, 793, 934, 1044, i595)- 

Infantile (nocturnal or diurnal) enuresis is a sexual discharge, Urinary excre- 
tion originally served as an autoerotic activity which gave the child urethral-erotic 
(and cutaneous) satisfaction. Memories of these autoerotic sensations are some- 



CONVERSION 


233 


times revived by patients under analysis — for example, in cases of ejaculatio prae- 
cox, where semen and urine are unconsciously equated. If, however, an already 
trained older child returns to this form of infantile satisfaction, it is no longer 
autoerotic; it is connected with fantasies concerning objects. If it is no longer per- 
formed actively and with conscious sexual pleasure but happens against the in- 
dividual’s will, it certainly may be called a conversion symptom. Between the in- 
fantile autoerotic wetting and the later symptom of enuresis there was a time of 
masturbation; and the enuresis represents a substitute and equivalent of sup- 
pressed masturbation. In some cases it is actually possible to demonstrate that a 
prohibition of masturbation served as a stimulant in the direction of the develop- 
ment of enuresis as a substitute behavior. Like masturbation, enuresis may fulfill 
the role of an efferent function for various sexual wishes. At the height of the 
development of the Oedipus complex it is first and foremost a discharge instru- 
ment of the Oedipus impulses. But just as in the case of other conversion symp- 
toms, various intermediary wishes are interpolated between the deeply repressed 
Oedipus complex and the final urethral- and skin-erotic symptoms. It is inter- 
esting to note that bedwetting is very often an expression of sexual fantasies 
proper to the opposite sex. Girls in whom urethral eroticism is well marked are 
almost always dominated by an intense envy of the penis. Their symptom gives 
expression to the wish to urinate like a boy. In boys the incontinence usu- 
ally has the meaning of a female trait; such boys hope to obtain female kinds 
of pleasure by “urinating passively.’* Further, the passive way of urinating may 
express a regression to the early passive-receptive ways of pleasure, a yearning 
for the freedoms of babyhood. Actually, enuresis frequently represents a wish to 
have the privileges of a baby again. The symptom is often precipitated by the 
birth of a sibling. Sometimes the bedwetting in such cases has a pronouncedly 
aggressive, spiteful significance aimed at hurting the parents’ feelings: “I will 
take the privileges of a baby, which you deny me.” The aggressive and spiteful 
significance of the symptom may give an opportunity to express simultaneously 
other pregenitally (orally) determined ideas of revenge; this frequently occurs in 
those cases of enuresis that form the basis for a subsequent ejaculatio praecox. 

The symptom of enuresis may have various consequences in the further devel- 
opment of the child. The tendency to suppress the symptom may, in a twofold 
way, influence character development, (i) It may turn the unspecific fear of 
“one’s own dangerous impulses” into the specific fear of “losing control.” And 
it is not infrequent that in analyzing patients’ difficulties in giving in to free 
association in the analytic cure, a fear of wetting is found as the basis. (However, 
the fear of being overwhelmed by one’s own excitement may also have other ori- 
gins.) This is more frequently found in girls, where frigidity is often character- 
ized by the unconscious idea that a full yielding to the climax of excitement would 
bring the disgrace of losing bladder control. The fact that this fear is more fre- 
quent in women probably is due to the circumstance that the retention of urine 
for the purpose of preventing enuresis is more apt to evoke a secondary erogenous 
retention pleasure (analogous to the anal retention pleasure) in girls than in boys. 
(2) The general fear of one’s own dangerous instincts might acquire the special 
quality of shame. The specific connection between shame and urethral eroticism 
has already been mentioned {see p. 69). Whereas rectal incontinence in children 
is usually directly and actively punished, cnurctic children arc made to feel 



234 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

ashamed, Pillorizing is the most frequent punishment. Ambition as a urethrah 
erotic character trait is the striving to avoid this kind of shame {see pp. 492 f.). 
Fecal incontinence is a much rarer occurrence in older children than urinary 
incontinence. It, too, has to be looked upon as a conversion symptom, expressing 
an unconscious tendency for anal discharge of instinctual conflicts. If it only hap- 
pens occasionally, it probably represents an equivalent of anxiety. If it happens 
habitually, however, it represents a retention of anal sexual execution or a regres- 
sion to it as an equivalent or substitute for masturbation. This certainly is a sign 
of a marked anal-erotic orientation. Actually, a history of anal incontinence is 
found more frequently in persons who subsequently develop compulsion neuroses 
than in those who develop hysterias. 

It seems like a contradiction of the general thesis about hysterics’ repressing 
their sexuality that hysterics so often are described as persons who are con- 
stantly preoccupied with sexuality, and who tend to “sexualize” any human 
relationship. But this contradiction is only an apparent one. Just because these 
persons block their sexuality, their sexuality is dammed up inside them, and there- 
fore comes out in unsuitable places and at inconvenient times. Hysterical eroto- 
mania is a pseudo hypersexuality caused by lack of satisfaction {see pp. 242 ff.). 

Sometimes patients with conversion symptoms are entirely free from anxiety; 
sometimes conversion and anxiety symptoms are developed alongside each other. 
The binding of the energy which has been dammed up through the neurotic 
conflict in alterations of somatic functions provides a certain capacity for dis- 
charge or at least for a more permanent binding of the cathexes, and as such is a 
means of getting rid of anxiety or of avoiding the open outbreak of it. In the 
cases in which anxiety is developed alongside conversion symptoms, this sec- 
ondary elaboration of the anxiety has failed or was not sufficient. 


COURSE AND PSYCHOANALYTIC TREATMENT OF CONVERSION HYSTERIA 

Certain reactions of the patient’s ego to conversion symptoms are so character- 
istic for hysteria that a few words about them may be said here in anticipation. 
On the one hand the ego attempts to continue the effort to repress the symp- 
toms as a derivative of infantile sexuality, just as it previously repressed infantile 
sexuality itseE By so doing, the ego strives to separate the symptoms from the 
rest of the personality, to ignore them; when the tendency to deny the symptoms 
succeeds, the patient’s attitude toward his symptoms is what Charcot, as reported 
by Freud, called la belle indifference des hysteriques (589) . On the other hand 
since they arc unavoidable, the ego endeavors to utilize the symptoms for its 
own purposes. If it must suffer, it wishes to get as much out of it as it can. In 
this way, secondary gains from the illness arc established, which are to be 
differentiated from the primary one, namely, the avoidance of facing the Oedipus 
complex. To say that a wish for a pension can cause a hysteria has been justly 



CONVERSION 235 

compared by Freud to the idea that a soldier in battle had his leg shot off in 
order to get a pension (618). 

The prognosis of psychoanalysis in cases of conversion neuroses is favorable. 
In typical cases, the course of the treatment is especially satisfactory, in so far as 
the patients react immediately to interpretations with alterations in transference 
and symptomatology and thus offer an unfailing criterion of the progress of the 
analysis. Psychoanalytic therapy is most clearly indicated except in cases where 
individual complications originating in external circumstances or in the charac- 
ter structure of the patient (481) unpleasantly complicate the situation. Only 
those factors which, apart from the diagnosis, generally are barriers to psycho- 
analytic therapy {see pp. 575 ff.) are contraindications here, too. Wherever imme- 
diate help is mandatory, or where the complicated apparatus of analysis seems 
unnecessary because simpler measures will suffice, or in those rare cases where 
hysteria seems to be the best way out of an intolerable real conflict, or where 
there is an exceptionally great secondary gain, or advanced age, it is, of course, 
necessary to give careful consideration to the question whether or not to start 
psychoanalytic treatment. 



Chapter XIII 
ORGAN NEUROSES 

WHAT IS AN ORGAN-NEUROTIC SYMPTOM? 

Not all somatic changes of a psychogenic nature should be called conversions 
because not all are translations of specific fantasies into a “body language ” 
Unconscious instinctual attitudes may influence organic functions in a physio- 
logical way, also without the changes having any definite psychic meaning. 
This difference, though very simple, is not always recognized. It was defined 
long ago by Freud in his paper on the psychogenic disturbances of vision (571). 
He says: 

“Psychoanalysis is fully prepared to grant, indeed to postulate, that not every 
functional visual disturbance is necessarily psychogenic. . . . When an organ 
which serves two purposes overplays its erotogenic part, it is in general to be 
expected that this will not occur without alterations in its response to stimulation 
and in innervation, which will be manifested as disturbances of the organ in its 
function as servant of the ego. And indeed, when we observe an organ which 
ordinarily serves the purpose of sensorial perception presenting as a result of the 
exaggeration of its erotogenic role precisely the behavior of a genital, we shall 
even expect that there are toxic modifications as well in that organ. For both 
kinds of functional disturbances ... we are obliged to retain, for want of a 
better, the time-honored, inapposite name of neurotic disturbances. Neurotic 
disturbances of vision are related to psychogenic as, in general, are the actual 
neuroses to the psychoneuroses; psychogenic visual disturbances can hardly 
occur, without neurotic disturbances, though the latter surely can without the 
former. Unfortunately, these neurotic symptoms are as yet little appreciated and 
understood, for they are not directly accessible to psychoanalysis.’* 

The sentences quoted are of basic importance, although the terminology is 
rather confusing. There are two categories of functional disturbances. One of 
them is physical in nature and consists of physiological changes caused by the 
inappropriate use of the function in question. The other one has a specific uncon- 
scious meaning, is an expression of a fantasy in a “body language” and is directly 
accessible to psychoanalysis in the same way as a dream. Freud calls both cate- 
gories neurotic and does not suggest any special term for the first category, 
whereas the second category is called psychogenic. This is rather confusing, 
because any misuse of an organ is psychogenic, too. It would be preferable to 
call the first category of symptoms organ neurotic, whereas for the second cate- 
gory the term conversion should be reserved. 



ORGAN NEUROSES 237 

Whereas the concept of conversion is very strictly defined, the first category 
needs further clarification. 

Between the realm of organic disorders from mechanical, physical, and chemi- 
cal causes and the field of conversion, there stretches a large field of functional 
and even anatomical alterations, which the term organ neurotic is meant to em- 
brace. The modern term “psychosomatic” disturbances has the disadvantage of 
suggesting a dualism that does not exist. Every disease is “psychosomatic”; for 
no “somatic” disease is entirely free from “psychic” influence — an accident may 
have occurred for psychogenic reasons, and not only the resistance against in- 
fections but all vital functions are continually influenced by the emotional state 
of the organism — and even the most “psychic” conversion may be based on 
a purely “somatic” compliance. 

The quotation from Freud contains the key for a classification of the organ- 
neurotic or psychosomatic phenomena. These sentences actually allude to two 
different things. Functional changes due to “toxic” influences, that is, to changes 
of the chemistry of the unsatisfied and dammed-up person, are not necessarily 
identical with changes caused by an unconscious use of these functions for in- 
stinctual purposes. Moreover, a third and simpler possibility must be considered 
first— the already mentioned affect equivalents. Thus four classes of organ- 
neurotic symptoms have to be distinguished: (i) affect equivalents; (2) results 
of changes in the chemistry of the unsatisfied and dammed-up person (expres- 
sions of “unconscious affects”) ; (3) physical results of unconscious attitudes or 
unconsciously determined behavior patterns; (4) all kinds of combinations of 
these three possibilities. 

AFFECT EQUIVALENTS 

All affects (archaic discharge syndromes that replace voluntary actions) are 
carried out by motor or secretory means. The specific physical expressions of 
any given affect may occur without the corresponding specific mental experi- 
ences, that is, without the person’s being aware of their affective significance. Sex- 
ual excitement as well as anxiety may be supplanted by sensations in the intestinal, 
respiratory, or circulatory apparatus (545). A certain percentage of what arc 
called organ neuroses actually are affect equivalents. Especially the so-called 
cardiac neuroses, which sometimes are conversion hysterias, seem frequently to 
be anxiety equivalents. The same holds true for those vegetative neuroses that 
occur when a compulsion neurotic or a reactive neurotic character gets disturbed 
in its relative rigidity. There arc also “subjective affect equivalents.” Once an 
emotion in childhood has become associated with a certain physical attitude, this 
attitude may be used in later life as a (distorting) expression of the emotion in 
question (316). 

The fact that affect equivalents have a diminished discharge value as compared 



23^ THE PSYCHOANALYTIC THEORY OF NEUROSIS 

with fully experienced affects may result in the affective attitude becoming 
chronic (Breuer and Freud called it strangulated affects) (i88). Symptoms cre- 
ated by chronic affective attitudes without adequate discharge may cease to be 
pure affect equivalents and belong rather in the next category. 

THE DISTURBED CHEMISTRY OF THE UNSATISFIED PERSON 

In the discussion of the nature of actual-neurotic symptoms (see pp. 185 ff.) the 
physical orientation of expressions like source of an instinct, satisfaction, frustra- 
tion, state of being dammed up, became clear. These expressions refer to chemi- 
cal as well as to nervous alterations. It is the hormonal state of the organism that 
forms the source of the instincts. The way in which external stimuli are perceived 
and reacted to depends upon it, and the instinctual action that brings about the 
cessation of the drive does so by altering the disturbing chemical condition. The 
omission of such action, whether determined by external circumstances or, as 
in the psychoneuroses, by internal inhibitions, necessarily interferes with the 
natural chemistry of the processes of excitation and gratification. 

The normal interrelationship of hormonal physiology and instinctual phe- 
nomena has been the subject of a study by Benedek and Rubenstcin, who tried 
to correlate psychoanalytic findings in women patients with their ovarian cycle 
(102). Although some of their conclusions may be open to criticism and require 
thorough checking, it can be stated that they have shown that instinctual im- 
pulses are actually dependent upon the hormonal state, and that psychodynamic 
changes secondarily influence the ovarian function. 

Whereas actual-neurotic symptoms proved to be general and unspecific expres- 
sions of the state of being dammed up (see p. 188), symptoms due to the changed 
chemistry of a person with a disturbed instinctual economy may also be of a 
more specific nature; furthermore, other intermediary factors may be inter- 
polated between the original drive and the final symptoms. In especial, those un- 
conscious readinesses to develop specific affects that are the result of repressions 
certainly change the physical functions of the individual, and eventually the 
tissues themselves (41, 43, 48, 313, 315, 317, 1350, 1607). They have been called 
unconscious affects (608). In affect equivalents the mental content of the affect 
has been warded off, whereas the physical concomitants of the affect do take place. 
Now we are talking about states in which even the physical discharge is really 
warded off (see p. 188). Everybody knows what a latent rage or a latent anxiety 
is: a state in which neither rage nor anxiety is felt but where there is a readiness 
to react with exaggerated rage or exaggerated anxiety to stimuli that would 
normally provoke a slight rage or a slight anxiety. Certainly the qualities of 
feelings come into being only by their beirig felt, but there are states of tension 
which, were they not hindered in their development and discharge, would re- 
sult in specific emotions. These are unconscious dispositions toward these quali- 



ORGAN NEUROSES 


239 


ties, unconscious “readiness for affects,” strivings for their development, which 
are held in check by opposing forces, even while the individual is unaware of 
such readiness. “Unconscious” anxiety (1629) and “unconscious” sexual ex- 
citement in this sense are paramount in the psychology of the neuroses. 

In considering the relationship between actual neuroses and psychoneuroses 
we may add that, theoretically, all psychoneuroses could be described as a sub- 
category of symptoms due to the disturbed chemistry of the dammed-up in- 
dividual. Freud always stressed the fact that all neuroses will turn out, in the 
last analysis, to be organic diseases. However, this organic basis of the average 
psychoneurosis is entirely hypothetical, whereas certain physical symptoms of 
“unconscious” or “strangulated” affects arc now accessible to research. Uncon- 
scious affects probably cause quantitatively and qualitatively different pourings 
out of hormones, and in this way influence the vegetative nervous system and the 
physical functions (343). Alexander is of the opinion that the difference in the 
hormonal state in conscious and in unconscious affects is only due to the chroni- 
city of the so-called unconscious affective attitudes (56). It is more probable, 
however, that the physical concomitants of unconscious affects are also quali- 
tatively different from those of conscious ones. It is even possible that these 
pourings out may be as specific as the physical syndromes of conscious affects, 
but this has been insufficiently investigated as yet. 

PHYSICAL RESULTS OF UNCONSCIOUS ATTITUDES 

The behavior of a person is continually influenced by his conscious and uncon- 
scious instinctual needs. Whereas the oscillations of conscious drives are regu- 
lated automatically through instinctual actions, warded-off impulses, which can- 
not find an adequate outlet but over and over seek to find discharge and to 
produce derivatives, have less obvious and more lasting effects. Attempts at 
substitute outlets are continued or repeated, and this may eventually produce 
physical alterations. 

A simple example: A habitual forced clearing of the throat, kept up over 
weeks and months, has a drying effect upon the throat and may eventually result 
in a pharyngitis. Or the habit of sleeping with the mouth open also dries the 
throat and may cause a pharyngitis. Both habits at times may have organic 
causes; at other times they certainly are an expression of unconscious wishes 
(532). There are many kinds of behavior that provoke common colds (1125, 
1352). Various authors have illustrated occurrences of this kind in detail (43, 56, 
317? 342? 343> 53^j 13567 1592) and have written papers about special “psycho- 
somatic” conditions, to he quoted later. 

To summarize: An unusual attitude, which is rooted in unconscious instinctual 
conflicts, causes a certain behavior. This behavior in turn causes somatic changes 
in the tissues. The changes are not directly psychogenic; but the person’s be- , 



240 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


havior, which initiated the changes, was psychogenic; the attitude was intended 
to relieve the internal pressure; the somatic symptom, which was the consequence 
of the attitude, was not sought by the person, either consciously or unconsciously. 


HORMONAL AND VEGETATIVE DYSFUNCTIONS 

The three categories of organ-neurotic symptoms, affect equivalents, physical 
expressions of a disturbed chemistry, and physical expressions of unconscious 
attitudes, appear usually in a combined form. Often the symptoms remain 
limited to a given organ or system of organs, the choice depending primarily on 
physical and constitutional factors but also on all the other factors that like- 
wise determine the “somatic compliance” in conversion symptoms (^see pp. 227 f .) . 
The hormonal-vegetative system, however, cannot be simply classified as one 
of the various organ systems, such as the intestinal, respiratory, or circulatory 
system. Rather, the greater part of the functional disturbances in these systems 
is created through hormonal-vegetative pathways, the symptoms “due to the 
distorted chemistry of the unsatisfied person” being exclusively determined in 
this way. Thus when introducing the heading “Hormonal and Vegetative 
Dysfunctions” before discussing the various organ systems, we only intend to 
discuss the influence of unconscious attitudes on hormones and to clarify a few 
points that occasionally are confused. 

Attitudes caused by unconscious instinctual conflicts may, of course, influence 
the hormonal functions and thus produce secondary somatic symptoms not 
intended as such. The same kind of influence that an unconscious desire has on 
the production of the gastric juice in cases of peptic ulcer {see p. 245), other 
desires have on the production of hormones regulating metabolism (c/. 189), 
for instance a psychogenic identification with the opposite sex. 

There is no doubt that in menstrual or premenstrual mental disorders in 
women, a somatic factor always plays a part, namely, the physical alterations at 
the source of the instinctual drives. But on the other hand the unconscious sig- 
nificance of the idea of menstruation and the mental reaction to this significance 
may likewise alter the hormonal events. In cases of disturbances, the pre- 
menstrual body feeling represents tension, retention (sometimes pregnancy), 
dirt, pregenitality, hatred; the menstrual flow may bring relaxation, and is felt as 
evacuation (sometimes birth), cleanliness, genitality, love; but it may also repre- 
sent loss of anal and urethral control, Oedipus guilt, castration, the frustration of 
wishes for a child, and humiliation. 

Every pregenital fixation necessarily changes the hormonal status. However, 
not all orally fixated patients become either obese or extremely thin. Probably 
.this happens if an oral fixation coincides with a certain hormonal constitution. 
Many cases of obesity and extreme thinness belong in this category. 



ORGAN NEUROSES 


241 


Hilde Bruch who has had a great and extraordinary experience with obese 
children (209, 21 1), states that the majority of cases do not seem to be primarily 
hormonal in nature but rather psychogenic, that is, brought about by an incor- 
rect economics of energy, by too much food supply and too little motor discharge. 
Psychoanalytically, this mistake in economy is due to primary psychogenic con- 
flicts or developmental disturbances. "‘Obesity in childhood represents a dis- 
turbance in personality in which excessive bodily size becomes the expressive 
organ of a conflict” (210). 

Wulfl has described a psychoneurosis, not infrequent in women, which is 
related to hysteria, cyclothymia and addiction (1619). This neurosis is char- 
acterized by the person’s fight against her sexuality which, through previous 
repression, has become especially greedy and insatiable. This sexuality is pre- 
genitally oriented, and sexual satisfaction is perceived of as a “dirty meal.” Pe- 
riods of depression in which the patients stuff themselves (or drink) and feel 
themselves “fat,” “bloated,” “dirty,” “untidy,” or “pregnant” and leave their 
surroundings untidy, too, alternate with “good” periods in which they behave 
ascetically, feel slim, and conduct themselves either normally or with some ela- 
tion. The body feeling in the “fat” periods turns out to be a repetition of the 
way the girl felt at puberty before her first menstruation, and the spells often 
actually coincide with the premenstrual period. The menstrual flow then usually 
brings a feeling of relief: “The fat-making dirt is pouring out; now I am slim 
again, and will be a good girl and not eat too much.” The alternating feelings of 
ugliness and beauty connected with these periods show that exhibitionistic con- 
flicts also are of basic importance in this syndrome. Psychoanalysis discloses that 
the unconscious content of this syndrome is a preoedipal mother conflict, which 
may be covered by an oral-sadistic Oedipus complex. The patients have an intense 
unconscious hatred against their mothers and against femininity. To them being 
fat means getting breasts, being uncontrolled, incontinent or even pregnant. The 
urge to eat has the unconscious aim of incorporating something that may relax 
the disagreeable inner “feminine” tension, eating meaning reincorporation of an 
object, whose loss has caused the patient to feel hungry, constipated, castrated, 
feminine, fat; that is, the food means milk, penis, child, and narcissistic supplies 
which soothe anxieties. The exhibitionistic behavior signifies a tendency to compel 
the receipt of these supplies and the fear of not getting them because of repulsive 
ugliness. The depression signifies the recurrent failure of the tendency to regain 
the lost stability, a failure that occurs because of the forbidden oral-sadistic means 
by which this re-establishment is attempted. The ascetic periods, by pacifying the 
superego, achieve a greater degree of relaxation. 

In some cases this neurosis is nothing but a kind of food addiction, and should 
rather be discussed in the chapter on addictions {see p. 381). In other cases, how- 
ever, not only body feelings but actual body changes dominate the picture. Ccr- 



242 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


tain cases of obesity, especially of cyclical obesity, accord in structure with Wulffs 
description. 

In a patient who actually lost a great deal of weight with every menstruation, 
which brought a sudden relief from an unbearable premenstrual tension, the 
changes in weight were mainly due to cyclical alterations of her water metabo- 
lism, When the patient felt disorderly inwardly, her metabolism actually behaved 
in a disorderly manner. Water played a leading role in the unconscious fanta- 
sies of this patient. The deep pregcnital mother binding as well as the early penis 
envy were urethroerotically determined; “castration,” because of certain child- 
hood experiences, was thought of as “developing a hydrocephalus.” 

In another case the periodic changes of weight were due to actual spells of stuff- 
ing. The craving for food was a craving to get rid of the dangers of femininity; 
but on the other hand it created a severe guilt feeling because of its hidden sadis- 
tic meaning. The patient felt well and “masculine” when, after menstruation, 
she succeeded in being ascetic. Both cases had irregularity of the menses, described 
by their doctors as “probably due to psychogenic factors.” 


DIGRESSION ON HYPER- AND HYPOSEXUALITY 

Before discussing special organ systems with reference to organ neuroses, a 
digression should be made into the psychology of hypo- and hypersexuality, 
although their connection with alterations in the hormonal functions is prob- 
lematic or even doubtful. Theoretically, of course, such cases may be purely 
organic in nature, the result of a somatic endocrine disorder. Not much is known 
about neurotic reactions in such cases. 

Much more frequently the hypo- or hypersexuality is apparent only and is due 
to psychogenic factors. 

The diagnosis of “hyposexuality” is frequently due to a gross mix-up in the 
concepts of genitality and sexuality. Ostensibly deficient in sexual desire are 
those persons whose libido runs along other than genital channels. In the final 
analysis, all neurotic persons suffer from a disturbance of their sexuality, which, 
in their unconscious, has an infantile significance. The amount of libido bound in 
their symptoms or deprived by repression from adequate discharge is lacking in 
their actual sexual behavior. The neurotic’s constant struggle with his repressed 
sexuality diminishes his disposable sexual energy. In certain cases the amount lack- 
ing may be sufficiently small to let the patient’s sexual life superficially appear 
undisturbed, and to let him feel subjectively as if his sexuality were satisfactory. 
However, the great majority of neurotics have gross and manifest sexual dis- 
turbances. These disturbances may express themselves in a diminution of con- 
scious sexual interest. (They may, however, also be expressed in the very opposite 
way: sexuality, deprived of its natural outlet, may “sexualize” everything.) A 
psychogenic decrease in sexuality thus is no separate clinical entity but rather a 



ORGAN NEUROSES ^43 

phenomenon that may occur in all neuroses, and that is to be included among the 
states of “inhibitions” {see p. 169). 

The impression of hypersexuality may be created by the same factors that 
produce hyposexuality. Deprived o£ real satisfaction, many neurotic persons 
strive time and again (and always in vain) to discharge through genital activity 
the sexuality they are unable to satisfy. They thus produce the impression of 
being very vigorous genitally (555). If neurotics boast of the number of times in 
succession they can perform the sexual act, it takes no very profound analysis to 
perceive that the apparent plus conceals a real minus, A normal person loses his 
desire when satisfied. The neurotic suffers from an incapacity for satisfaction ; he 
is “orgastically impotent” (1270). Hence he may attempt to achieve satisfaction 
by persistent repetitions of the sexual act. The inability to achieve satisfying 
relaxation also explains why most “hypersexual” persons are chronic neuras- 
thenics as well; the amount of libido that finds no outlet in their genital activity 
produces restlessness, disturbance of the capacity for work, and so on. 

The inability to attain genuine end pleasure induces many neurotics to lay 
more stress on the forepleasure mechanisms. This can hardly be ascribed to a 
greedy need of perpetual pleasure (1220); rather the cause is to be sought in 
the insufficiency of their orgastic function. (Usually an exaggerated insistence 
on forepleasure is determined by an anal-erotic fixation, for pleasure due to ten- 
sion is experienced most acutely in anal retention.) 

What has been said until now is correct for all neurotics. There must be an 
additional factor determining the nature of those cases in which the “hyper- 
sexuality” is so marked as to dominate the clinical picture, 

Don Juan’s behavior (1251) is no doubt due to his Oedipus complex. He seeks 
his mother in all women and cannot find her (572) . But the analysis of Don Juan 
types shows that their Oedipus complex is of a particular kind. It is dominated 
by the pregenital aim of incorporation, pervaded by narcissistic needs and tinged 
with sadistic impulses. In other words, the striving for sexual satisfaction is still 
condensed with the striving for getting narcissistic supplies in order to maintain 
self-esteem. There is a readiness to develop sadistic" reactions if this need is not 
immediately satisfied. 

It is due to the archaic nature of the typical Don Juan’s Oedipus complex that 
he is so little interested in the personality of his objects. He has not passed the 
archaic pre-stages of love. His sexual activities are primarily designed to contra- 
dict an inner feeling of inferiority by proof of erotic “successes.” After having 
“made” a woman, he is no longer interested in her, first because she, too, has 
failed to bring about the longed-for relaxation, and second because his narcissistic 
need requires proof of his ability to excite women; after he knows that he is able 
to excite a specific woman, his doubts arise concerning other women whom he 



244 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


has not yet tried. Perverse inclinations of any kind may give rise to similar clinical 
pictures. An unconsciously homosexual man, for example, may be aroused by 
sexual contact with women but not satisfied; he then vainly seeks satisfaction in 
more and more sexual activity. 

Pollution dreams following sexual intercourse betray the fact that the inter- 
course has been exciting but not satisfactory; they demonstrate an orgastic impo- 
tence; analysis of dreams of this kind leads to an understanding of the above- 
mentioned factors. 

In general, exaggerated sexual activity is an “obsession” like any other exag- 
gerated activity; that is, it is a derivative, an unsuccessful attempt to use the 
genital apparatus for discharging some nongenital, warded-off, and dammed-up 
need. 

Actually an apparent sexual behavior sometimes covers a striving for power 
or prestige {see pp. 515 ff.). However, the exaggerated striving for power and 
prestige has, in such persons, a history that leads back again to infantile sexuality. 
Power and prestige arc needed as defenses against an anxiety that has become 
connected with infantile sexual strivings. 

Nymphomania, which is feminine pseudo hypersexuality, is based on the 
analogous psychological structure. A superficial anamnesis often shows that 
nymphomanic women are either totally frigid or at least do not have orgasms 
regularly or readily. The fact that intercourse may excite them but cannot satisfy 
them creates the desire to force the unattainable satisfaction by renewed and 
increased attempts, or by trials with different men or under different circum- 
stances. And as in the male Don Juans, analysis shows that the condition depends 
on a marked narcissistic attitude, on a dependency on narcissistic supplies, on an 
intense fear over loss of love, and a corresponding pregenital and sadistic colora- 
tion of the total sexuality. The attitude toward the object is typically ambivalent 
because, consciously or unconsciously, he is believed to be responsible for the 
failure to attain satisfaction. The sadistic attitude is manifest in the attempt to 
coerce the partner by violence into “giving” complete sexual satisfaction and 
therewith a re-establishment of self-esteem. This may be combined with the 
revenge type of the female castration complex (20). What is so intensely desired is 
associativcly intimately bound up with the envy of the penis, and thus nympho- 
manic passion often aims to fulfill the wish fantasy of depriving the man of his 
penis. The manner in which this penis is incorporated in fantasy indicates that 
the ostensibly incessant genital desire is pseudo genital and, basically, of an oral 
nature. Analysis uncovers early infantile experiences in the realm of the pre- 
ocdipal inother relationship which from the beginning gave the subsequent 
Oedipus complex an oral, demanding imprint (421). Normally with the trans- 
position of the sexual excitability from the clitoris to the vagina, the previous 
oral orientation is mobilized again. Nymphomanic women are excessively 



ORGAN NEUROSES 


245 


aflFected by this process, so that their vagina unconsciously signifies a mouth. 
Again, as in the case of male hypersexuality, similar symptoms may appear as a 
result of other unconscious perverse inclinations. 

Not all hypersexual men and women have the capacity for alloplastic action. 
If persons of this type are more inhibited, excessive masturbation takes the place 
of excessive sexual intercourse. Excessive masturbation represents an attempt to 
find a genital discharge for nongenital tensions, which cannot succeed {see 
p.384). 

GASTROINTESTINAL TRACT 

A good example of an organ neurosis psychoanalytically understood as a 
physical result of an unconscious attitude is peptic ulcer as seen by the research 
work of the Chicago Psychoanalytic Institute (43, 758, 1031). 

Persons with a chronically frustrated oral-receptive demanding attitude, who 
have repressed this attitude and often manifest very active behavior of the 
reaction-formation type, are, unconsciously, permanently “hungry for love.” It 
would be even more exact to state that they are “hungry for necessary narcissistic 
supplies,” and the word hungry in this connection has to be taken literally. This 
permanent hunger makes them act like an actually hungry person does. The 
mucous membrane of the stomach begins to secrete, just as does that of a person 
who anticipates food, this secretion having no other, specific psychic meaning. 
This chronic hypersecretion is the immediate cause of the ulcer. The ulcer is the 
incidental physiological consequence of a psychogenic attitude; it is not a dis- 
torted satisfaction of a repressed instinct. 

It may be questioned whether this etiology is valid for all cases of ulcer. It is 
possible that the functional changes which, in some cases, arc brought about by 
repressed oral eroticism may be determined in other cases by purely somatic 
causes. 

It is easily understandable that a colitis may be brought about by unconscious 
anal impulses that are continuously effective, similar to the way by which the 
secretions of the gastric juices are produced by unconscious oral demands. Such 
a colitis is the result of the organism’s being chronically under eliminative and 
retentive pressure, as an ulcer may be the result of a chronic receptive pressure. 
The conflict between eliminative and retentive tendencies itself may be deter- 
mined in different ways. It may represent a simple conflict between (anal) sexual 
excitement and fear; or the feces may represent introjected objects which the 
person wishes to preserve as well as to get rid of (67, 305, 306, 1034, 1165, 1589). 

Children who like to postpone defecation (either for the sake of retention 
pleasure or because of fear) later often develop obstipation; the retention, which 
was- voluntary in the beginning, has become an organ-neurotic symptom (555). 
The prolonged continuance of an obstipation must influence the smooth muscles 



^4^ THE PSYCHOANALYTIC THEORY OP NEUROSIS 

of the intestinal tract. A spastic colon, that is, a readiness to react to various 
stimuli either with constipation or with diarrhea or with both, is either an anxiety 
equivalent or a sign of the patient’s fixation on the anal phase of his libidinal 
development. No matter what stimulus started the excitation, the execution is an 
intestinal one. It may also be a symptom of a continuous and repressed aggres- 
siveness, sometimes as a revenge for oral frustrations (104, no, 302). In a deeper 
layer, then, diarrhea may express generosity or a readiness to sacrifice. Or it may 
reflect fantasies concerning internalized objects. 

In neurasthenia, constipation is one of the characteristic symptoms. This is 
due to the fact that ‘^retention” generally characterizes the state of being dammed 
up, which is the basis of neurasthenia (1268, 1381). Also among organ-neurotic 
symptoms in general, retention symptoms are frequent. However, organ-neurotic 
symptoms are also “emergency discharges.” Some symptoms are compromises 
between retention and elimination. Some cases of spastic colitis have obstipation 
and diarrhea alternately. Certain types of pathological defecation betray a castra- 
tion anxiety, displaced to the anal sphere. 

Alexander took the relation between ulcer and colitis as a starting point for 
the idea that neuroses in general and organ neuroses in particular could be 
understood in their specific nature by measuring the relative participation of the 
three basic directions in which an organism’s tendencies toward the external 
world may be effective: reception, elimination, and retention. He called the 
investigation of the relative participation of these three factors in a given phe- 
nomenon vector analysis (44) . This point of view certainly is useful — for example, 
in the study of the differential etiology of ulcer and colitis. It also has drawbacks 
which will be discussed later {see p. 526). 

MUSCULAR SYSTEM 

The physical effects of the state of being dammed up emotionally are readily 
reflected in the muscular system. Pathogenic defenses generally aim at barring 
the warded-off impulses from motility (the barring from consciousness is only 
a means of achieving this) ; thus pathogenic defense always means the blocking 
of certain movements. This inhibition of movements means a partial weakening 
of the voluntary mastery of motility. Thus the struggle of the defense reflects 
itself in functional disturbances of the voluntary muscular system. The existence 
of these disturbances contradicts Alexander’s idea that all disturbances in the 
muscular functions are conversions, whereas disturbances in the vegetative func- 
tions are organ neuroses (48, 56). When persons with localized or general mus- 
cular spasms that hinder their motility try to relax their spastic muscles, they 
are either totally unable to do so or they may fail into emotional states, as 
patients in a psychocathartic treatment do if their thoughts approach their com- 



ORGAN NEUROSES 


247 


plexes. This shows that the spasm was a means of keeping the repressed in re- 
pression. The observation of a patient during an acute struggle over repression 
likewise demonstrates this. A patient in psychoanalysis who can no longer avoid 
seeing that an interpretation is correct, but nevertheless tries to, frequently shows 
a cramping of his entire muscular system or of certain parts cf it. It is as if he 
wanted to counterpoise an external muscular pressure to the internal pressure 
of the repressed impulses seeking an outlet in motility. 

A patient whose speech was impeded was at first entirely unable to talk in 
analysis. She became visibly spastic whenever she tried to talk, tensing her mus- 
cles and clenching her fists. She experienced her inability to speak physically; she 
felt cramped, especially in the chest and limbs; she could “let nothing out” of 
her; after an hour of silence, she was as exhausted as after violent physical exer- 
tion. When she again became able to speak, it was like a sudden release. “I can’t 
tell you how physical that is,” she would say. Characteristically, the patient de- 
scribed her spasms as localized beneath the lower ribs (spasm of the diaphragm). 

Ferenczi noted that many patients, particularly while showing resistance, dis- 
play “an exaggerated stiffness in all limbs . . . which can turn into catatonic 
rigidity while exchanging greetings or taking leave, which need not necessarily 
imply schizophrenia. With the progress of the analysis, the physical tensions may 
disappear along with the solution of the mental ones” (505)* 

The muscular expression of an instinctual conflict is not always a hypertonic 
one. Hypotonic lax (“flappy”) muscular attitudes, too, block or hinder muscular 
readiness. Hyper- and hypotonic states may alternate; thus the whole field is 
better designated as psychogenic “dystonia” (410). 

Dystonia and intensity of repression are not necessarily proportionate- to each 
other. Not only the question whether and to what extent mental conflicts find 
expression in alterations of muscular function but also the type and location of 
these alterations are very different in individual cases. Whether the dystonia 
concerns more the skeletal or the smooth muscles or both is different in different 
persons, probably due to both constitutional and early environmental influences; 
and this difference is decisive for the subsequent “psychosoipatic” history* The 
location of the symptoms depends on physiological as well as on psychological 
factors. One of these factors is easily recognizable; it is the specificity of the de- 
fense mechanism used. In the case of compulsion neurotics the mechanism of 
displacement of spasms of the sphincters will play a more important part; in 
hysterics, the blocking of inner perceptions will be more predominant. Investiga- 
tion will have to show in what cases and under what circumstances defense and 
muscular dysfunctions run parallel and where they diverge considerably. 

Spasms paralyzing skeletal muscles are one of the physical signs of anxiety; 
they may appear as an anxiety equivalent. 

A patient reported that her calisthenics teacher used to call her attention to 
the extremely cramped, tense condition of the muscles in her neck. Her attempts 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


248 

to relax only increased the tension, and a feeling of nausea would follow. Analysis 
revealed that as a child the patient had seen a pigeon having its neck wrung and 
had then watched the headless pigeon flapping about for a while. This experience 
had given lasting form to her castration complex; she had an unconscious fear of 
being beheaded, which also manifested itself in other symptoms, modes of be- 
havior, and directions of interest. 

In some persons a dystonic behavior is an expression of an anal retentive 
tendency (505). Not only fear but also other affects, especially spite and sup- 
pressed rage, may be physically expressed as a muscular spasm. 

That sexual drives are at the basis of a dystonia is frequently substantiated by 
the fact that the most severe spasm is that of the pelvic muscles. The original 
autoerotic libidinization of the muscular system may be regressively revived. 
Just as repression represents a dynamic struggle between impulse and coun- 
tercathexis, so does the dystonia represent a struggle between motor impulse 
and a tendency to block the intended movement. 

Psychogenic dystonia seems to be decisive in certain organ-neurotic gynecologi- 
cal conditions, in which a hypotonus of the pelvic muscles may have unfavorable 
consequences that were not necessarily unconsciously intended as such (27, 359, 
902, 1128, ii39«, 1144, 1306). Psychogenic dystonia may also be the decisive etio- 
logical factor in conditions like torticollis (268, 270, 1576). 

It is very interesting that these disturbances of muscular functions arc mainly 
co-ordinated with disturbances of inner sensitivity and of body feeling. The 
muscular functions become normal again if it is possible to re-establish aware- 
ness of the warded-off body sensations. Actually, dystonic phenomena accom- 
pany hysterical disturbances of sensitivity and general frigidity (410). 

A patient with strong exhibitionistic leanings, overcompensated by excessive 
modesty, had to undergo an examination by a gynecologist. She struggled against 
it for a long time, fearing that she could not survive such an ordeal. Just as it was 
finally to take place, something strange happened. She suddenly lost all feeling 
of her own body. The lower part of her body was '‘alien,” did not belong to her 
any more, and she could now let herself be examined. 

Another patient demonstrated the connection between spasm and alienation. 

At a time when her castration anxiety, connected with infantile masturbation, 
had been mobilized in her analysis, she had to undergo an operation necessitating 
an anesthetic. She awoke from it feeling a “stiffness” in her arms and simulta- 
neously having the sensation that her arms did not belong to her. This condition 
repeated itself on several occasions in analysis when her associations touched on 
the subject of infantile masturbation. 

Thus organ-neurotic dysfunctions of the muscles arc closely interwoven with 
corresponding dysfunctions in muscular sensations (1311). 



ORGAN NEUROSES 


249 


The existence of a psychogenic dystonia has been taken as a starting point for 
various forms of “relaxation** therapies of neuroses (334, 839, 1280, 1410). How- 
ever, usually the relaxation is not attainable as long as the defensive conflicts pre- 
vent it; sometimes a lax hypotonus is mistaken for relaxation; or a split between 
the mental state and its physical expression is achieved, so that a change of the 
muscular attitude may occur without a corresponding change in the mental dy- 
namics. But apparently there are cases in which a genuine mobilization of the 
mental conflicts reflected in the muscular state may be evoked by the therapist 
through a kind of “seduction” to relaxation; this possibility may warrant the use 
of relaxation exercises as a method or as an auxiliary of cathartic treatment {see 
P- 555 )- 

A continuous misuse of the muscles for “neurotic” spasms has necessarily a 
tiring effect. Actually the fatigue characteristic for all actual-neurotic states is 
probably due to the “dystonic** innervation of muscles. This fatigue is most out- 
spoken in cases of inhibited aggressiveness; often it can be directly called an 
equivalent of depression. 

Not much study has been done concerning psychogenic pains in muscles. 
Sometimes such pains are fully developed conversion symptoms. At other times, 
however, pains seem to be the result of dystonia. This probably holds true for 
certain types of lower backache. 

Rheumatic diseases, the symptoms of which of course are not limited to the 
muscular system, apparently may also be influenced by psychogenic components, 
or at least by psychogenic predispositions. Dunbar distinguishes between two 
types, one of which is more “extraverted” and traumatophilic, tending toward 
afflictions of the joints, the other more “introverted,** ambivalent, vacillating be- 
tween activity and passivity, and inclined toward heart afflictions (343). 

Not much is known about the part played by psychogenic factors in the 
etiology of some types of arthritis (1087, 1214, 1534). There are indications that 
in somatically predisposed personalities a continuous unconscious tendency to 
suppress movements may result not only in muscular spasms but also in un- 
specific alterations of the tissues of the joints. 

A case of arthritis of the Bechterew type was characterized by the extremely 
important role played by pleasure in movements (and exhibitionism) during 
childhood. The girl had intended to become a dancer who would charm audU 
ences by her beauty. Her father’s criticisms broke up these fantasies and made her 
believe that she was rejected because of her lack of a penis. Thereafter she felt 
that she was not permitted to dance. She developed an intense reactive aggressive- 
ness of which she was afraid and for which she tried to overcompensate. To the 
patient, her arthritis, which began many years later, meant punishment for and 
final prohibition of her dancing ambition, her exhibitionism and her reactive cas- 
tration tendencies. The significance of these factors in the etiology of the arthritis 
was not disclosed. 



250 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


RESPIRATORY SYSTEM 

Breathing, like other muscular functions, has its characteristic dystonia. Varia- 
tions of respiratory rhythm, especially transitory cessations of breathing, and 
variable and irregular participation of individual parts of the thorax in the act of 
breathing are the ways in which continuous, small psychological alterations exert 
an influence on the process of respiration (50, 54, 515). These phenomena be- 
come particularly evident when a new action or motion is initiated and in every 
change of direction of attention (807, 1519, 1539). The intimate connection 
between anxiety and respiration makes it probable that these constant variations 
in the respiratory function express slight degrees of anxiety. The “normal” res- 
piratory dystonia may be considered as an anxiety signal of low intensity. It is 
as if the ego were cautiously testing the path, whenever a new thing is perceived, 
a new action undertaken, or the attention redirected — wondering, so to speak, 
whether or not it should be afraid. 

“Signal anxiety” is a lower degree of “traumatic anxiety.” Certainly crass altera- 
tions of the respiratory function also play an essential part in intense anxiety 
spells, and may later be used as anxiety equivalents. The awareness of the role 
played by respiratory sensations in anxiety in general explains the fact that 
every anxiety, to a certain extent, is felt as a kind of suffocation (741). Therefore, 
neurotic anxiety manifesting itself in respiratory symptoms is not necessarily a 
sign that the warded-off impulses concern respiratory eroticism. The reverse, 
rather, may be true: respiration may acquire an erotic quality only after and 
because anxiety has become connected with sexual excitement. 

Sometimes a manifest fear of suffocation covers a repressed idea of castration. 

A patient imagined that the analyst might cut off his supply of air with scissors. 

He fantasied that his supply of air was arranged like that of a diverts and was 
being cut off by his analyst, thus choking him. This fantasy was a cover for the 
anxiety lest the scissors cut off his penis. The connection between the ideas of cas- 
tration and suffocation was the fear that he might suffocate during sleep under 
the blanket, a fear that had been prominent during his' latency period. While under 
the blanket, he used to indulge in masturbatory fantasies. 

However, the respiratory function may also have become “sexualized.” In 
infancy, smelling and sniffling are not only connected with sucking (1184) but 
are in themselves a source of erogenous pleasure; this pleasure and infantile 
conflicts around it may be remobilized in a subsequent neurosis. Intake and 
outlet of air may symbolize “incorporation” and “projection of what had been 
incorporated.” In primitive thinking, the respiratory apparatus becomes the site 
of incorporated objects, in the same way as does the intestinal apparatus. Primi- 
tive people, psychotics, and children sense that, by breathing, they are taking in 
some substance from the outer world and returning some substance to it. The 



ORGAN NEUROSES 


. 251 


incorporated substance is invisible and therefore suitable for conveying magical 
ideas, which is reflected in the equations of life and soul with breathing (1320). 
Breathing further lends itself to magical use because of the fact that it is the one 
vegetative function that can be regulated and influenced voluntarily. Inhaling the 
same air as another person means to be united with him, while exhaling means 
separation. "‘Respiratory introjection” is closely tied up with the “taking in of 
odors,” that is, with anal eroticism on the one hand and with the idea of identifi- 
cation with dead persons (“inhaling the soul”) on the other (420). 

In bronchial asthma, it is particularly a passive-receptive longing for the mother 
which is expressed in pathological changes of the breathing function (53^? 535 ’ 
1190, 1563, 1615). The asthmatic seizure is, first of all, an anxiety equivalent. It 
is a cry for help, directed toward the mother, whom the patient tries to introject 
by respiration in order to be permanently protected. This intended incorporation 
as well as the instinctual danger against which it is directed are characteristically 
of a pregenital, especially anal, nature; in fact, the whole character of the typical 
asthmatic patient shows pregenital features; the Oedipus complex of patients 
suffering from asthma has a typically pregenital character. Often the introjection 
is fantasied as already accomplished, and there are conflicts between the ego of 
the patient and his respiratory apparatus, representing an introjected object. It 
must be added that in asthma, purely somatic factors (of an allergic nature) 
(1355, 1509) likewise play a role, as well as full conversions (of a pregenital na- 
ture) (^f<? pp, 321 ff.). 

French and Alexander, who made a detailed psychoanalytic study of bronchial 
asthma (535), summarize their results in the following way which fully accords 
with the previous description: . . first that the asthmatic attack is a reaction 

to the danger of separation from the mother; second, that the attack is a sort of 
equivalent of an inhibited and repressed cry of anxiety or rage; third, that the 
sources of danger of losing the mother are due to some temptations to which the 
patient is exposed.” The task of “mastering the fear of being left alone governs 
the patient’s whole life” (318). 

It has been mentioned that common colds are frequendy an unintentional 
result of various neurotic behavior patterns (1125, 135^5 ^ 59 ^) ‘ easily 

explained why the very persons who are afraid of colds tend to catch them fre- 
quently. Their fear expresses insight into their tendency to catch colds, and 
through the returning of the repressed, their attempts to avoid colds paradoxically 
direct them into situations that make them susceptible to colds. 

The various kinds of “nervous coughing” may be classified as follows (443): 
(i) Coughing of an organic origin may produce disturbances of the mental econ- 
omy; the patient’s adjustment to the symptom may fail in the sense of a “patho- 
ncurosis.” (2) A cough of organic origin may be used secondarily for the pur- 
pose of giving discharge to repressed impulses, especially for expressing conflicts 



252 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

around incorporation. (3) Nervous coughing may be a conversion symptom, 
either a hysterical identification w^ith a coughing person (557) rn^y» 

through memories of organic childhood coughs, express some instinctual con- 
flicts of childhood (1591). (4) Some nervous coughing is of the nature of a tic, 
being a substitute for and an equivalent of embarrassment or hostility. (5) Nerv- 
ous coughing may be an organ-neurotic symptom, caused by a cold induced by 
some psychogenic behavior. 


HEART AND CIRCULATORY SYSTEM 

Rage and sexual excitation as well as anxiety manifest themselves physiologi- 
cally in functional circulatory alterations. The heart is considered the organ of 
love, the heart beats fast in rage and fear, the heart is heavy if one feels sad. Vago- 
and sympathicotonic reactions are the very essence of the physical components 
of affect syndromes. These components may always serve as affect equivalents if 
a person wards off awareness of his emotions. Any kind of “unconscious emo- 
tion” may express itself in acceleration of the pulse. 

However, certain personalities seem to be especially predisposed to develop 
just this type of expression. These personalities are by no means identical with 
those who have somatically impaired hearts. The “nervous heart” often has 
objectively the strongest power of resistance. The “somatic compliance” of the 
nervous heart, it seems, lies not in the heart but rather in the vegetative nervous 
system and its chemical and central control systems (71). 

However, the contents of the leading conflicts also seem to be characteristic for 
these personalities. Whereas sexual excitement certainly may occasionally dis- 
guise itself also as palpitation, a chronic irritability of heart and circulatory sys- 
tem is more typically due to unconscious aggressiveness and retaliation fear of 
aggressiveness. Characteristically, such patients suffer from an inhibited hate 
toward the parent of the same sex, and simultaneously from a fear of losing his 
or her love or affection, if this hate were openly expressed. The fear of being 
abandoned, carried over from infantile experiences, takes the form of a fear of 
death. Very often an identification with a cardiac sufferer in the patient’s environ- 
ment is in the foreground (especially if the patient has wished for the death of 
this person and now fears retaliation). Attacks are frequently precipitated if 
circumstances necessitate competition with the parent of the same sex; the patient 
then tries unconsciously to escape into a passive-dependent attitude (344, 1129, 
1150, 1608). These are apparently the typical unconscious conflicts in cases called 
effort syndrome (342, 1572) . 

A patient with heart symptoms had not only generally identified himself with 
his father, a cardiac sufferer, but unconsciously had introjected his father and 
then equated his heart and his father (s^e pp. 219 f.). 



ORGAN NEUROSES 


253 

It has been demonstrated that extrasystoles are sometimes immediate reactions 
to events that stimulate repressed conflicts (728). However, certainly not all 
cxtrasystoles have such a tangible mental precipitator. 

Deutsch and Kauf (312) have studied the physiological pathways of nervous 
system and chemical control by which psychogenic factors may influence the 
circulatory functions. 

There seems to be a correspondence between the fact that persons who 
block the external discharge of their emotions entirely are more disposed toward 
reaction within the circulatory system and the physiological fact that the 
circulatory system, as contrasted with the digestive and respiratory tracts, is 
closed and not capable of intake or discharge. 

General vasomotor reactions such as blushing, turning pale, fainting, and 
dizzy spells are very common in neuroses. This is due to the fact that vasomotor 
expressions are in the foreground of the physical manifestations of all affects and 
that vasomotor reactions are ready channels for emergency discharge whenever 
muscular discharge is blocked. 

Vasomotor alterations, probably in combination with certain dystonic mus- 
cular phenomena, are also the cause of the majority of nervous headaches. The 
physiology of nervous headaches still presents many unsolved problems; psycho- 
logically it can be stated that actual-neurotic headaches, expressing a state of 
inner tension, organ-neurotic headaches, due to a more specific behavior caused 
by an unconscious conflict (e.g., specific muscular tensions during sleep), and 
conversion headaches (e.g., expressing pregnancy fantasies) should be distin- 
guished from one another. 

Investigation of the personalities of patients suffering from migraine show 
that they must regularly be classified as “neurotic characters” of marked emo- 
tional instability (1544). They are easily frightened or depressed, are always 
ready to accept blame, have sexual inhibitions, and frequently an intense attach- 
ment to their parents. The authors stress that the patients give the impression of 
constandy fighting an unconscious hostility (972). Fromm-Reichmann (656) is 
of the opinion that the symptom is produced when an unconscious hostile tend- 
ency is directed in particular at the destruction of an object's intelligence (“men- 
tal castration”) and guilt feelings turn this tendency instead against one’s own 
head. 

The severe “vegetative neuroses,” like Quinke’s edema or Raynaud’s dis- 
ease, have not yet been psychoanalytically investigated as to their possible psycho- 
genic components, 

BLOOD PRESSURE 

Even in cases where the exact physiological pathways by which an organ- 
neurotic symptom is actually brought about are not yet known, it is possible to 



254 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


sec what the underlying psychogenic attitude is. An example for this is essential 
hypertension which just recently has been made the subject of psychoanalytic re- 
search (51, 52, 783, 1134, 1353, 1413, 1571, 1572). Cases of essential hypertension are 
characterized by an extreme, unconscious instinctual tension, a general readi- 
ness for aggressiveness as well as a passive-receptive longing to get rid of the 
aggressiveness. Both tendencies arc unconscious and are effective in persons 
who superficially seem to be very calm and permit themselves no outlets for 
their impulses. This unrealized inner tension seems to be at least one of the 
etiological components of essential hypertension; it becomes effective through 
hormonal influences due to unconscious conflicts via vasomotor responses and the 
kidneys; further physiological research will have to show exactly in which ways. 
The increase in essential hypertension in modern man is probably connected 
with the mental situation of individuals who, having learned that aggressiveness 
is bad, have to live in a world where an enormous amount of aggressiveness is 
asked for. 


SKIN 

For physiological reasons, manifestations on the skin often express irritations 
in the endocrine-vegetative system, and it is this connection that explains the 
tendency for the skin to become the site of emergency discharges in states of 
nervous tension. The simple symptom of nervous sweating and the symptom of 
dermography are examples for the general vegetative irritability of the skin in 
response to (conscious and unconscious) emotional stimuli. These symptoms 
may be chronic as a sign of the patient’s state of inner tension or they may appear 
as temporary symptoms during actual neuroses; or they may appear in the form 
of “spells,” whenever an event touches upon unconscious conflicts; or they may 
have become elaborated into conversion symptoms (676, 1151, 1199, 1387, 1507, 
1510). There is no doubt that cutaneous irritability reflects vasomotor instability. 
A dermatologist who specialized in the study of the psychology of dermatoses, 
Barinbaum, put the problem as follows: “One would like to know how the ex- 
citation of a disturbed libido economy influences the vessels of the skin, since 
function and state of the skin depend on its vessels to the highest degree” (86). 

The tendency of the skin to be influenced by vasomotor reactions, which in 
turn arc evoked by unconscious impulses, has to be understood from the point 
of view of the general physiological functions of the skin. Four characteristics of 
the skin as the external cover of the organism, representing the boundary between 
it and the external world, arc of general importance. 

I. The skin as the covering layer has, first of all, a general protecting function* 
It examines incoming stimuli and, if necessary, blunts them or even wards them 
off. For the purpose of applying the same protective measures against internal 
stimuli, the organism has a general tendency to treat disturbing internal sdifiuli 



ORGAN NEUROSES 


255 


as if they were external ones (605). This tendency also holds true for repressed 
impulses seeking discharge. In the same way that muscles become rigid un- 
specifically in the struggle against repressed impulses, so vasomotor functions of 
the skin, too, are used as an “armor.” Physiology will have to explain how these 
vasomotor changes result in the outbreak of a dermatosis. 

2. The skin is an important erogenous zone; if the drive to use it as such is re- 
pressed, the recurrent tendencies for and against cutaneous stimulation find 
somatic expression in cutaneous alterations. 

The erogeneity of the skin is not limited to touching stimuli. Sensations of tem- 
perature are the source of an erogenous pleasure which is an important compo- 
nent of infantile sexuality. The displeasure of feeling cold and the pleasure of 
being warm again are as old as the displeasure of being hungry and the pleasure 
of being fed again. Actually oral and temperature eroticism regularly make their 
appearance together. Therefore, the narcissistic supplies, wanted urgently by per- 
sons with oral fixations, are thought of not only as food but also as warmth. 

In addition to the stimuli of touching and temperature, pain, too, may be a 
source of erogenous cutaneous pleasure. In cases where the sexual aim of being 
beaten is paramount, this pleasure has become the representation of the individ- 
ual’s total sexuality {see pp. 359 f.). Actually, sado-masochistic conflicts arc often 
found as the unconscious basis of dermatoses. 

It has been suggested that outbreaks of psoriasis in particular may represent 
sadistic impulses turned against one’s own ego (381, 1240). However, it docs not 
seem probable that psoriasis has the nature of a conversion symptom. Psychogenic 
forces may be rather one determining factor among others, and it may be that 
certain sadistic strivings, if not discharged, influence the skin via chemical and 
nervous alterations. 

3. The skin as the surface of the organism is the part that is externally visible; 
this makes it a site for the expression of conflicts around exhibitionism. These 
conflicts in their turn concern not only a sexual component instinct and opposing 
fear or shame but also various narcissistic needs for reassurance. Hence the same 
unconscious conflicts found in phobias around beauty and ugliness p. 201), 
in cases of perverse exhibitionism {see pp. 345 if.) , or in cases of social fear and 
stage fright {see pp. 518 if,), may also be found as the basis of dermatoses. 

4. Anxiety equivalents, too, may be localized as reactions of the skin. Anxiety 
is physiologically a sympathicotonic state, and sympathicotonic reactions of ves- 
sels in the skin may represent anxiety. 

As to special affections of the skin, the torturing symptoms of pruritus proba- 
bly are an organ-neurotic result of repressed sexuality in predisposed individuals 
(341). In men with pruritus ani and pcrinci, there seems to be a more specific 
connection with congestion due to undischarged anal-erotic (homosexual) trends 
(1351). It can sometimes be observed that the symptom becomes worse whenever 
latent homosexuality is mobilized. However, the impression persists that the 
pruritus has no specific “meaning” that could be retranslated into words. Prob- 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


256 

ably the unconscious anal longings change the vascular responses of the whole 
region in such a way as to influence its chemistry. The corresponding comment 
can be made about pruritus vulvae in women who do not dare to masturbate 
and dam up their genital excitement. 

Urticaria, as is well known, may have a varied etiology. It may be an allergic 
reaction without mental connotations. It may be an organ-neurotic “dermatosis,” 
Saul and Bernstein are of the opinion that attacks of urticaria occur in states of 
an intense frustrated longing that cannot find any other discharge (1357; see also 
1194). It may be that “emotional urticaria” is the expression of an allergic re- 
action to certain hormones mobilized by the emotion. 

Perhaps further research will make it possible to subdivide the dermatoses into 
damming-up types and discharge types. 

EYE 

It has been mentioned that the mechanisms of organ-neurotic symptoms were 
first described by Freud in the example of eye symptoms (571; see also 823). 

There has been some discussion in psychoanalytic literature about psychogenic 
myopia. In taking psychogenic myopia as a kind of conversion symptom, the 
question was asked: What does the patient gain by not being able to see distant 
objects or by hiding his face behind a pair of spectacles (720, 860) ? 

Put in this way, the question seems unwarranted. If there is a psychic factor in 
the genesis of myopia, it must be an organ-neurotic one. From the point of view 
of research, it is probably more useful to discover what somatic changes in the 
eye have resulted from its being used for libidinous purposes than to regard the 
incapacity to see at a distance as a symbol of castration. 

Myopia is caused by an elongation of the axis of the eyeball. This elongation is 
attributed partly to the external muscles of the eye and partly to alterations in the 
lens and to general vegetative changes that alter the contour of the eyeball itself. 
It would seem, then, that an incapacity to see distant objects has no psychic signif- 
icance but is the involuntary, mechanical sequel to sympathico-parasympathetic 
processes which affect either the external optic muscles or the sympathico- 
parasympathetic tonus within the eyeball. But what causes these processes? In 
any event the vegetative nervous system is, of course, dependent on the uncon- 
scious affective status of a person. Constant use of the eye for libidinous gratifica- 
tion of scoptophilic impulses may cause it actively to strain in the direction of 
objects in order psychically to incorporate them. It is conceivable that this may 
finally result in a stretching of the eyeball (430). 

This, of course, is putting the problem very crudely. Exact knowledge of the 
mechanisms of such stretching would be necessary to explain why many persons 
with particularly strong scoptophilic impulses are not at all shortsighted. There 
is no diflSculty about the converse fact, namely, that many shortsighted persons 


1 



ORGAN NEUROSES 


^57 


show no sign of a marked unconscious scoptophilic tendency. There is no reason 
to suppose tfiat every case of myopia is psychogenically determined. While the 
stretching of the eyeball may sometimes be due to the attempt to incorporate 
objects at the bidding of scoptophilic impulses, in other cases the origin of the 
disability is undoubtedly purely somatic. 

Patients with psychosomatic disorders of a more severe type and those who 
are chronically inclined to respond to any strain with physical symptoms usually 
show a rather clear-cut narcissistic orientation. This is a remarkable difference 
between them and conversion hysterics. Sometimes the organ neurosis gives the 
impression of being a protective defense against (and an equivalent of) a psy- 
chosis (1120, 1442). It can be assumed that the increase in cathexis of organ 
representatives, characteristic for all narcissistic states, facilitates the development 
of organ-neurotic symptoms. 

PROBLEMS OF THE PSYCHOGENESIS OF ORGANIC DISEASES AND OF 
PATHONEUROSES 

Not every organic symptom wherein analysis can demonstrate a correlation be- 
tween it and mental connotations is necessarily of an organ-neurotic nature. Noth- 
ing happens in the organism without being drawn secondarily into the mental 
conflicts of the individual. The existence of such a conne«tion alone does not 
prove anything about the genesis. 

The coexistence in a patient of a tumor and of unconscious ideas of pregnancy 
or even the analytic proof of a coincidence of the development of a tumor and 
an intensification of the wish for pregnancy must not lead to unwarranted 
etiological conclusions. Even if the patient at a time preceding the diagnosis of 
the tumor dreams of being pregnant, though this would perhaps show that un- 
consciously he was aware of the tumor before he knew of it consciously, it does 
not indicate that the wish to be pregnant may have caused the development of 
the tumor. 

A further complication in the relation between an organic symptom and men- 
tal conflicts is brought about by the fact that somatically determined conditions 
may secondarily change the psychic attitudes of the individual. The adaptation 
to pain or to changes of body functions is not always easy. The ways in which 
this adaptation is attempted, and whether or not it succeeds, depend, of course, 
on the total structure of the personality, its history, and its latent defense strug- 
gles. First of all, the somatic process in the organ requires much of the libido 
and the mental attention of the person; again, his other interests and object rela- 
tionships are relatively impoverished, which explains why in general being sick 
makes a person narcissistic (585). Besides, the disease or physical change 
may unconsciously represent something to the patient which disturbs the exist- 
ing equilibrium between repressed and repressing forces; a disease may, like a 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


258 

trauma, be taken as a castration or as an abandonment by fate, or at least as a 
threat of castration or abandonment; it may also be perceived as a masochistic 
temptation, or mobilize some other latent infantile longing and in this way pro- 
voke a neurosis. 

The narcissistic withdrawal of the sick person as well as his unconscious misin- 
terpretations of the disease in terms of instinctual conflicts are at the basis of the 
fact that neuroses sometimes develop as a consequence rather than as a cause of 
somatic diseases. Ferenezi called neuroses that are consequences of somatic dis- 
eases pathoneuroses (478) . 

Freud’s statement that the sick person withdraws his libido from objects and 
becomes narcissistic (585) has been doubted because, according to Freud him- 
self, this is what occurs in psychoses (574) . Is it conceivable that the same process 
may be operative under such diflferent conditions as the feelings of a mentally 
normal, physically sick person and a schizophrenic.? The difference between the 
physically and the psychotically ill person is, to be sure, considerable. But there 
are also certain characteristic similarities, namely, the loss of externally directed 
interests and the increase in self -observation and self-interest. The physically ill in- 
dividual has relegated a small part of his libido, and for a short time only, to the 
same fate as the psychotic individual has imposed on almost the sum total of his 
libido. 

_A confirmation of this point of view is to be found in the fact that patho- 
neuroses often show reactions that are psychotic in character. This led Meng to 
speak of pathopsychoses (1120). It is also true that individuals with a tendency 
toward narcissistic regression are predisposed to the development of patho- 
neuroses, and that pathoneuroses arc most likely to develop as a result of an 
affliction of those organs that are most highly cathected narcissistically, such as 
the genital organs and the brain. Pathoneuroses also express the difficulties of the 
task of adapting oneself to the real (or imaginary) limitations set by a disease. 
Extreme cases try to deny or to overcompensate real consequences entirely; the 
majority of acute postoperative psychoses belong to this group (62, 1368, 1628), 
Ferenezi and Hollos have proved that much of the symptomatology of general 
paresis is not a direct consequence of the degenerative processes in the brain, but 
an indirect pathoneurotic reaction on the part of the patient to his becoming 
aware of the cerebral impairment (484; see also 1376). The aim of some psychoses 
after mutilating operations is very evidently a denial of the unpleasant reality; 
the clinical picture then is dominated by the struggle between the data of percep- 
tion and the tendency to deny them. 

In other organic brain diseases, too, the reaction of the mental personality to 
the disease — the struggle between attempts to adapt oneself to or even to make 
use of the organically determined symptoms and attempts to deny them — com- 
prises part of the clinical picture (281, 723, 864, 1028, 1206, 1373, 1379, 1382, 



ORGAN NEUROSES 


259 


148O5 1593). The conflicts are very illustrative, even contributing to the un- 
derstanding of the adaptive functions of the normal ego during its develop- 
ment. Likewise Jellifle’s attempts to ‘psychoanalyze’* encephalitic symptoms 
(861, 862, 865; cf, also 801) should be understood as a study of the ways in which 
the personality reacts to or makes use of the symptoms rather than as a belief 
in the “psychogcnesis** of encephalitis. 

Sometimes the acute narcissism provoked by an organic disease operates as a 
precipitating factor for the outbreak of an ordinary psychosis. 

A special category of pathoneuroses, appearing mostly in combination with 
disturbances “due to changed chemistry,” are the hormonal pathoneuroses. 

A quantitative or qualitative change at the source of the instincts must neces- 
sarily also influence the intensity and nature of the instinctual conflicts and their 
mental outcome. The authors who have worked in this field stress especially the 
interrelation of hormonal and mental data, that is, the fact that neurotic symp- 
toms or attitudes in hormonally sick persons also influence the hormonal state. 
A psychogenic identification with a member of the opposite sex, for instance, 
may change the hormonal equilibrium; but also certain changes of the hormonal 
equilibrium may facilitate this type of identification. 

Therese Benedek analyzed patients with hyperthyroidism and was able to 
show that the somatically increased anxiety and restlessness stimulated mental 
reactions that differed in accordance with the different pre-morbid personality 
structure of the patients (98) . The anxiety was regularly connected with aggres- 
sive strivings, sometimes expressed by an increased strictness of the superego, and 
was antagonistic to heterosexual libido {cf, 1061). 

A case of eunuchoidism, psychoanalytically treated by Carmichael (244), 
showed a similar kind of interrelationship. 

The childhood history of this patient showed nothing that would have trans- • 
gressed the realm of normality. The organic disturbance manifested itself at pu- 
berty, and mental difficulties started when the patient became aware of it. He 
unconsciously interpreted his disease as “castration.” He developed into a “model 
boy,” whose anal and compulsive character became more and more pronounced. 
His character showed many traits that represented attempts at a denial or over- 
compensation of his “inferiority.” He even tried to deny the existence of any sex- 
ual feeling, and produced a complete amnesia for all his infantile sexual memo- 
ries. Likewise, he denied and ovcrcompensatcd his intense aggressive impulses 
which were based on his feeling of “being different.” 

Kasanin had the opportunity to study analytically two patients with tumors 
of hormonal glands (928). 

One patient had a tumor of the adrenal gland, the other a teratoma of the pineal 
body. Their mental pathological behavior seemed partly to be determined by an 
attempt to fight off or deny the somatic symptoms; partly, however, it seemed 



26 o 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


that the anxiety and depression experienced by the patients were not genuine 
emotions but rather the physiological syndrome of the emotions without the ac- 
companying mental experience of the specific feelings. This might have been 
due to defense; however, it might also have been due to the fact that the hormo- 
nal alterations produced only the peripheral physiological signs of affect and not 
the centrally determined full experience. 

Daniels published a detailed report of a patient with diabetes mellitus (303, 

304)- 

The patient was an intensely- oral character with a mental structure of the ad- 
dict type. Changes in the insulin requirements and m the urine sugar level were 
directly related to alterations of the emotional conflicts. The patient experienced 
much anxiety, which certainly was partly of a physiological origin, and developed 
various methods to ward off this anxiety by means of its sexualization. 

According to Dunbar (343) inconsistency and indecisiveness are characteristic 
traits of diabetic personalities. Diabetics have an increased tendency toward homo- 
sexuality> or at least a bisexual or pregenital orientation. They show signs of social 
anxiety and of a weak ego. They show similarities to the compulsive character 
{see pp. 530 ff.) and even tendencies toward psychotic reactions of a cyclothymic 
as well as of a paranoid type. During the illness, frequently a progredient disin- 
tegration of the total personality can be observed; hence diabetes has been called 
the psychosomatic psychosis. 

It seems that there are cases of “emotional glycosuria/^ due to the disturbed 
chemistry of the unsatisfied person. They have a good prognosis; their exact 
physiological pathways are not known. 

Mcng and Grotc psychoanalytically investigated cases of pathological thinness 
(1121). They did not find anything very specific but were able to show that men- 
tal factors play a definite role in the ups and downs of the disease, that is, that 
they influenced the hormonal state. 

Severe cases of anorexia show definite hormonal pathology; probably in some 
cases these alterations are primary ones. In others a primary disturbance of men- 
tal development, fixating the ego at the oral phase, may induce secondary hormo- 
nal changes (361, 1082, 1555). The mental significance of this fixation may vary; 
sometimes an anorexia represents an equivalent of a depression {see pp. 176 f.). 

The same holds true for obesity. There arc severe glandular disturbances 
(Frohlich^s disease, status adiposogenitalis) which influence the psychosexual 
development in the sense of retardation, oral fixation, and weakness of gcnitality. 
And there arc other cases of “genuine obesity” that represent organ neuroses, 
starting with psychogenic developmental disturbances and resulting in hormonal 
abnormalities (209, 210, 211, 1327). 

The opposite of a pathoneurosis would be a “patho-cure” of a neurosis that 
disappears with the outbreak ‘of an organic disease. This happens in moral 



ORGAN NEUROSES 


261 


masochists whose neuroses represent first of all a suffering by which they pacify 
their superego. Neuroses of this type become superfluous when replaced by 
another kind of suffering (see p. 550). 

Whenever a connection between an organic symptom and a mental conflict is 
encountered the first question must be: has the conflict produced the symptom 
or the symptom the conflict? No doubt there is sometimes a vicious circle, 
symptom and conflict perpetuating each other (182, 242, 317, 343, 858, 1137, 1233, 
1414, 1442, 1511, 1573), 


HYPOCHONDRIASIS 

Hypochondriasis is an organ neurosis whose physiological factor is still un- 
known. It may be assumed that certain psychogenic factors, namely, a state of 
being dammed up and a narcissistic withdrawal, or rather a readiness to react 
to a state of being dammed up with narcissistic withdrawal, create organic 
changes which then in turn give rise to hypochondriacal sensations. 

Theoretically, two situations have to be distinguished, though actually they 
are closely interwoven: (i) Organic processes due to the lack of adequate dis- 
charge heighten the tension in certain organs; this heightening makes itself felt 
as painful sensations. (2) A withdrawal of object cathexes changes the mental 
economics so that amounts of libido that were normally connected with the ideas 
of objects now intensify all ideas concerning one’s own organs (585, 1374). 

The term object cathexis means that the sum total of the ideas and feelings 
a person has in regard to another person constitutes an “intrapsychic object repre- 
sentation” (408), and that this representation is cathected with a special amount 
of mental energy. In an analogous way, an individual’s own body and its organs 
are represented intrapsychically by means of a sum of memories of sensations and 
their interrelations. The “body image” (1372) thus created has great significance 
for the constitution of the ego. It is not simply identical with the real body. 
Clothes, amputated members, or even one’s automobile may be included in the 
body image, whereas “alienated” organs arc excluded from it. Hence there are 
also “intrapsychic organ representations.” “Narcissistic withdrawal” means a 
transfer of libido from object representations to organ representations. 

That clothes unconsciously may be treated as parts of the body was demon- 
strated by a patient whose obsessive worries about his clothes turned out to be, 
descriptively as well as structurally and genetically, a “clothes hypochondriasis.’* 

The chemical and nervous reactions to the state of being dammed up may 
sometimes precipitate an intrapsychic overcathexis of the organ representations. 
In other cases the processes may occur in the opposite order: a regression to 
narcissism may change secondarily the physical functions of the organs. This is 



262 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


the case in the hypochondriacal sensations at the beginning of schizophrenic 
processes. 

The relation between cathexes of organ representations and physical processes 
in the organs manifests itself also in the previously discussed narcissism of sick 
persons. Apparently, in order to bring about the healing of a diseased organ and 
to raise the organ’s resistance to the illness, an increase in the cathexis of the organ 
representation is needed, or is at least beneficial. Thus the “body libido” has a 
general vital function. There is not only a morbid plus of organ cathexes in 
hypochondriasis; a morbid minus is conceivable as well. It can be assumed that 
self-sustenance depends upon the infusion of a certain amount of cathexis to the 
organ representations. Tausk spoke of a “libidinal tonus” of all organs (1531). In 
hypochondriasis as well as in psychoses, the results of a pathological libidinal 
hypertonus of the organs are manifested. In persons who are afraid of their body 
sensations and ward them off, there may also be a pathological libidinal hypo- 
tonus of the organs. 

Not every alienation of an organ and not every removal of jparts of the body 
or of sensations from the conscious body image can be interpreted as a pathologi- 
cal diminution of the cathexis of the organ representation. The organs or sensa- 
tions may be really repressed, that is, invested with cathexis, and yet at the same 
time counteracted and prevented from becoming manifest by an equally intense 
countercathexis (410), 

Hypochondriasis rarely appears as an isolated neurosis (1488). It appears more 
frequently as a factor complicating the picture of some other psychopathological 
condition. It is often combined with acute anxiety neurosis or neurasthenia. To a 
slight degree it is a complicating factor in some compulsion neuroses. To a 
higher degree it is an important complication in all psychoses, especially in their 
initial stages. Hypochondriasis may be brought about by a primary hyper- 
cathexis of the organ representations (in psychoses), or by primary unknown 
organic manifestations of the state of being dammed up (in actual neuroses). 

Among the impulses that are withdrawn from object to organ representations 
in hypochondriasis, the hostile and sadistic impulses appear to play a particularly 
pronounced role. The orginal hostile attitude toward an object is turned against 
the ego, and hypochondriasis may serve as a gratification of guilt feelings. 
Hypochondriacal sensations (“hypochondriacal delusions”) should be differ- 
entiated from hypochondriacal anxiety, although frequently these two conditions 
arc encountered together. In cases in which anxiety prevails, there seems to be 
rather an isolated hypercathexis of the organ representations, and in cases where 
sensations prevail, actual organic alterations. 

It sometimes happens that psychoanalysis uncovers in a surprisingly clear and 
definite way the unconscious significance of a given hypochondriacal anxiety. As 
a rule it represents, in a distorted manner, castration anxiety. 



ORGAN NEUROSES 


263 

As an example, the continuation of the analysis of the wolf-man by Ruth Mack 
Brunswick should be quoted. The wolf-man’s outspoken hypochondriacal delu- 
sions bore definite earmarks of castration anxiety (1088). 

Not infrequently psychoanalysis can also clarify the infantile history of the 
displacement of castration anxiety to hypochondriasis. Certain experiences may 
have transformed castration anxiety into fears of becoming ill or physically altered. 
The results are often clear-cut “sickness phobias.” In such cases, as a rule, the 
mechanism of introjection has acquired outstanding importance. When hostile 
impulses become turned away from an object onto one’s own organs, this process 
unconsciously is perceived as an introjection, usually an oral one, occasionally 
an anal, epidermal, or respiratory one. Hence the hypochondriacally affected 
organ represents not only the endangered penis but simultaneously the object 
which, along with its ambivalent cathexis, was introjected from the external 
world into one’s own body. 

The hypochondriasis of one patient had on the higher levels the significance 
of castration as a punishment; on a deeper level it meant a passive sexual grati- 
fication (pregnancy); on a still deeper level the organ affected was equated with 
the introjected object. The patient’s nose, which played the chief role in his ill- 
ness, stood not only for the endangered penis and the nostrils for a kind of anal 
feminine sex organ; the nose also stood for his dead mother, whom he had incor- 
porated via the respiratory system (420). 

Simmel has stressed especially the unconscious equation of the hypochon- 
driacally affected organ and the introjected object. He writes: “The introjected 
parental substitute becomes the morbid material which must be eliminated if 
the patient is to recover,” and further states that an organ may represent this mor- 
bid material (1436, 1438). 

Painful sensations and the fear of physical illness also appear in conversion 
and anxiety hysteria respectively, and there are cases in which it is practically a 
matter of choice whether they should be considered hysterical or hypochondria- 
cal. As a rule, however, it is not difficult to differentiate the hypochondriacal from 
the hysterical individual on the basis of personality traits that are due to dif- 
ferences in their libidinal situation. The typical hypochondriac is a conspicuously 
narcissistic; seclusive, monomaniacal creature (1380). Hypochrondriasis is thus a 
transitional state between reactions of a hysterical character and those of a delu- 
sional, clearly psychotic one. 

A patient with a severe vasomotor neurosis suffered from attacks of pseudo 
angina pectoris. The attacks appeared for the first time when the patient, soon 
after the death of his mother, learned that his father, too, had become seriously 
ill. The patient, an infantile-narcissistic individual who was fixated to his parents 
and had hitherto been unable to live without them, thus found himself suddenly 
confronted with the danger of having to face life alone. The pseudo angina had 



264 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

for him, first of all, the obvious meaning of an identification with his father, 
who was ill with heart disease. The patient lost interest in his parents as well as 
in other objects and devoted himself to his attacks and his fear of dying. He was 
afraid that his heart would abandon him, just as in reality he faced the danger 
of being deserted by his father. Although he obviously surrendered himself in a 
passive, rather masochistic manner to his illness, he also constantly cursed his 
own heart, thus showing that he had transferred the ambivalence he once felt 
toward his father onto his heart. In particular the patient’s dreams showed that 
his attitude toward his illness and his infantile attitude toward his father coin- 
cided. The validity of the unconscious equation heart- intro jected father does 
not necessarily mean that an “introjection of the father into the heart” created the 
attacks. The attacks were organ neurotic in nature; that is, they were brought 
about by certain vasomotor responses of the patient which in turn were due to 
his repressed emotions. 

Mention should be made here that not only may hypochondriasis in adult 
persons be an outcome of castration anxiety in childhood but sometimes, also, 
analysis reveals that some patients with a severe castration anxiety, who were 
frightened as little boys, then went through a period of a more or less severe 
hypochondriasis about their penis which later became limited to a simple fear. 


PSYCHOANALYTIC THERAPY IN ORGAN NEUROSES 

The great variety of phenomena designated organ neurotic makes impossible 
any general statement about their psychoanalytic treatment. There are states 
that have become ‘‘organic” to such an extent that immediate physical treatment 
is necessary. But whenever the symptoms are the outcome of chronic unconscious 
attitudes, psychoanalysis is indicated for the purpose of making this attitude 
conscious and thus overcoming it. 

Freud stated that the organ-neurotic symptoms are not “directly accessible” to 
psychoanalysis. Indirectly they are. If the anxiety or other obstacles hindering the 
adequate discharge of a person’s impulses are removed by analysis, the indirect 
symptoms disappear without having been made a specific object of psychoanaly- 
sis. The change of the function cannot be “analyzed” because it has no uncon- 
scious meaning; however, the attitude that produced it can be analyzed, and if 
the attitude is given up or the state of being dammed up is overcome, the in- 
voluntary consequences likewise disappear (41, 1350, 1592). 

It is clear that the attitude or the blocking of discharge and not the symptom 
itself is the object of analysis. A trial analysis will first have to estimate the relative 
etiological importance of the unconscious factors and establish a dynamic diag- 
nosis. A hysteria with the symptomatology limited to one single organ is, of 
course, not more difficult to analyze than any other hysteria; but the closer an 
organ neurosis is to a psychosis, the more doubtful is the prognosis. 



ORGAN NEUROSES 


265 

As to the treatment o£ pathoneuroses, a number of them, as should be expected 
from the nature of the disturbance, run an acute course and recover spon- 
taneously, when the basic somatic disease disappears. If the disease served as a 
precipitating factor of a genuine neurosis or psychosis, the treatment depends 
on the nature of the neurosis or psychosis provoked. 

Regarding hypochondriasis, again the rule is valid : the more hysteriform the 
picture (hypochondriasis simply representing castration anxiety), the better the 
prognosis; the more narcissism predominates, the more doubtful and uncertain. 
In regard to the ability to develop transference, severe hypochondriacal neuroses 
differ but little from psychoses. 

The ease or difficulty of eliminating the disturbances of an individual libido 
economy depends on the extent to which the individual has become psychologi- 
cally ready for the establishment of genital primacy; a person who has failed 
completely or almost completely to reach the level of infantile genitality, upon 
which a therapy subsequently has to rely, is badly off (1267). The decision 
whether or not to apply psychoanalytic therapy to such cases depends upon the 
capacity for the development of a transference and the status of the infantile 
genitality. These factors can be ascertained by trial analysis only. Yet one may 
say that in doubtful cases the indications are nevertheless in favor of psycho- 
analysis: many individuals of this type cannot be helped by any other therapeutic 
method, and psychoanalysis offers at least some hope. 


APPENDIX: EPILEPSY 

Much has been written about the “psychosomatic” relationship in epilepsy. 
This uncanny/ complex of symptoms is certainly prearranged organically; never- 
theless the appearance of the syndrome sometimes seems to be dependent on 
mental factors, and in some cases even to be aroused by mental factors. How 
would psychoanalysis classify such a disease (3, 90, 267, 269, 271, 272, 276, 280, 
339, 623, 714^, 765, 857, 863, 997, 1030, 1092, 1123, 1276, 1478, et al) } 

The epileptic seizure is best compared to a spell of affect, A traumatic stimulus, 
or a normal stimulus occurring when the organism is dammed up, precipitates a 
prearranged discharge syndrome, which breaks through the normal ego dom- 
inance over motility. This definition is equally valid for an affea attack and an 
epileptic seizure. The epileptic seizure can be looked upon as a kind of sp>ecial 
affect attack, which occurs only in certain organically predisposed personalities. 
The predisposition consists in the patient’s readiness to react to certain stimuli, 
or to the pressure of certain dammed-up states, with the production of this archaic 
. syndrome of explosive convulsive discharge. 

It is this predisposition that is caught in the characteristic changes of the dec* 
troencephalogram. 



266 the psychoanalytic theory of neurosis 

The stimuli that provoke the archaic reaction are of various kinds. Attacks of 
the “symptomatic” (Jackson) type occur as reflexive responses to purely physical 
stimuli; an organic injury of the brain results in higher levels of brain organiza- 
tion being inhibited and an archaic type of reaction being again produced. In 
genuine epilepsy, probably a more subtle brain defect of a still unknown type has 
the same effect; but the nature of the provoking stimuli and of the antecedent 
tension may become more specific. In some cases it becomes clear that specific 
mental impulses, instead of being reacted to on a higher level, provoke the seizure 
in a short circuit, as it were. Such a disease cannot be called an “organ neurosis 
of the brain” in the sense that a psychogenic attitude might have changed the 
reaction patterns of the central apparatus; however, it can be called so in the sense 
that the pressure of the repressed toward motility precipitates an archaic physio- 
logical syndrome, given a certain somatic disposition. It is, says Freud, as if the 
mechanism of the abnormal impulsive discharge were organically prepared in 
advance, to be called upon in quite different conditions, both during disturbances 
of the cerebral activity due to serious histolytic and toxic affections, and also in 
case of inadequate control of the psychic energy” (623). 

Clinical experience indicates that epileptic personalities are (a) generally very 
narcissistically oriented, showing the described features of an archaic ego and 
always ready to substitute identifications for object relationships, and (b) show 
very intense destructive and sadistic drives which have been repressed for a long 
time and which find an explosive discharge in the seizure. The repression of the 
destructive drives is due to an intense fear of retaliation, which often is very con- 
spicuous in the clinical picture. As is well known, the aura is that part of the 
epileptic seizure that varies the most. It can therefore be expected that the aura, 
which precedes the more uniform “archaic discharge syndrome,” will reveal 
more about the specific nature of the precipitating mental stimuli. This expecta- 
tion is fulfilled. Hendrick, by psychoanalyzing the contents of the aurae of several 
cases, found that before the seizure a tendency toward the development of anx- 
iety had been mobilized; then the incipient anxiety spell had been blocked, and 
the epileptic seizure occurred as a kind of substitute for the anxiety that was not 
experienced. “Discharge through the central nervous system replaced the dis- 
charge of autonomic tensions” (765). Experiences that provoke the spell turn 
out, in analysis, to be either allusions to repressed drives that were once experi- 
enced with anxiety or projective representations of the sensations of anxiety 
itself. The blocked anxiety probably is always a fear of the possibility that an 
intense and dammed-up destructiveness may be turned against one’s own ego* 
The ability to supplant anxiety by the specific central convulsive phenomena 
would represent a purely physiological problem. 

Bartemeier drew attention to the fact that in neurotic and normal persons, 
certain archaic explosive discharges occur which may be looked upon as normal 



ORGAN NEUROSES 


267 


prototypes of epileptic seizures, such as twitchings while falling asleep, grinding 
of the teeth and clenching of the jaw during sleep, unintentional biting of the 
tongue, and certain momentary disturbances of attention (90). All these phe- 
nomena are facilitated in states of fatigue and ego regression and in situations 
of latent rage. 

Epileptic phenomena, outside the realm .of seizure and aura, have not been 
investigated psychoanalytically as yet. However, a general speculative remark 
may be permitted about the final deterioration of certain cases. If the assumption 
is correct that the mental apparatus fulfills the functions of elaborating and 
finally discharging incoming stimuli, it is conceivable that a decisive change in 
the methods of discharge, through the establishment of a simple explosive and 
undifferentiated method, may result in a simplification and undifferentiation of 
the total mental apparatus. 

There is a gradual transition between genuine epilepsy and conversion hys- 
terias, in which epileptiform seizures express a definite idea and show all the 
characteristics of hysterical motor symptoms (hystero-epilepsy) (368, 647, 714^1, 
770, 1259, 1335, 1611). 



Chapter XIV 

OBSESSION AND COMPULSION 


THE PHENOMENON OF COMPULSION 

In all psychoneuroses the control of the ego has become relatively insufficient. In 
conversion symptoms, the ego is simply overthrown; actions occur that are not 
intended by the ego. In compulsions and obsessions, the fact that the ego gov- 
erns motility is not changed, but the ego does not feel free in using this govern- 
ing power. It has to use it according to a strange command of a more powerful 
agency, contradicting its judgment. It is compelled to do or to think, or to omit 
certain things; otherwise it feels menaced by terrible threats. 

Derivatives of warded-off impulses betray their nature as derivatives by their 
exaggerated character, that is, by the disproportion of the accompanying emo- 
tions or by the rigidity with which they are adhered to. Obsessional ideas are, 
first of all, derivatives. Sometimes they have preserved their character as im- 
pulses; sometimes they have lost it, and consist only of intense ideas that have 
to be thought about; their persistence represents the energy of some other asso- 
ciativcly connected impulsive ideii that had been warded off. 

Sometimes the transition of a phobia into an obsession can be observed directly. 
First, certain situations are avoided; then constant attention is exerted to ensure 
the necessary avoidance. Still later, this attention assumes an obsessive character, 
or another positive obsessive attitude is developed, so irreconcilable mth the 
situation originally feared that the avoidance is assured. Touching rituals re- 
place taboos; washing compulsions, fears of dirt; social rituals, social fears; sleep- 
ing ceremonials, fears of falling asleep; rituals about the manner of walking, 
inhibitions of walking; compulsive ways of dealing with animals or cripples, 
the corresponding phobias. 

Some phobic ideas gain an obsessive character by their mere intensity, for ex- 
ample, ideas of being ugly or of having a bad odor. They are obsessive ideas as 
long as the patient feels; “I am compelled to feel as if this or that were the case”; 
they arc delusions if the patient is convinced of their basis in fact. 

In other cases an obsession does not provide the avoidance of what was origi- 
nally feared but compels the person to do just that which he originally was afraid 
of. Obsessions of this type are not caused by a need for maintaining a phobia but 
rather by a fight of the original impulse or of the personality against the phobia. 

Such obsessions are but one category of counterphobic attitudes (435) (see 
pp. 480 ff.). An example is presented by a patient who had an obsessive interest in 
s^ing and water sports which was an outcome of an infantile fear of flushing the 



OBSESSION AND COMPULSION 2^9 

toilet. Fear of high places may be supplanted by the obsessive impulse to jump 
down. 

Compulsions are obsessions that are still felt as impulses; they, too, are de- 
rivatives; their intensity, too, expresses the intensity of warded-off drives. 

There are cases in which the distortion of the original instinctive impulse con- 
sists only in the fact that the “instinctive” urge has been changed into a “com- 
pulsive” urge. Obsessive thoughts about incestuous or murderous acts are not 
uncommon. They appear stripped of their character as instinctual wishes and of 
their appropriate emotional equality. Patients who try to express the fact that the 
horrible ideas are not felt as wishes often say that compulsive ideas of this kind 
“leave them cold.” Actually, since compulsions are tormenting, they do not leave 
them cold at all (6i8). The defensive forces did not succeed in making the pa- 
tients unaware of what is going on within them; they did succeed, however, in 
transforming the original drive into a compulsive form; the nature of this 
transformation is the problem of the mechanism of symptom formation in com- 
pulsion neurosis. 

A patient who suffered from the fear that he might give the impression of 
being a homosexual had the following obsessive thought whenever he became 
acquainted with a man whom he had not met before: “With this man I could 
have homosexual intercourse.” He did not feel any sexual excitement or impulse, 
and was entirely unaware of the fact that the obsessive idea expressed a wish. 

Other obsessions and compulsions do not seem to express a distorted instinc- 
tual urge but, as has been mentioned, an assurance of the defending forces. Com- 
pulsion can be described as a command from within. The idea of “being com- 
manded” certainly is rooted in the child’s experiences with grownups who used 
to “command” him, especially, in our culture, in experiences with the father. 
In compulsions this father commands from within; and an “inner father rep- 
resentative” is called superego. Thus in the formation of compulsive symptoms 
the superego plays a part different from that in conversion. 

Now, it seems, we have arrived at contradictory statements. First it was stated 
that the phenomenon of compulsion is a distortion of the phenomenon of in- 
stinctual urges; now it seems as if it were a. derivative of commands once given 
by the father to suppress instinctual demands. 


INSTINCT AND DEFENSE IN COMPULSION SYMPTOMS 

Actually, the phenomenon of compulsion is a condensation of both instinctual 
and anti-instinctual forces. The manifest clinical picture reveals the first aspect 
more in some cases, in others the second. The first holds true for obsessive in- 
cestuous or murderous ideas. More frequendy the symptoms obviously express 



270 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

distorted commands of the superego; the defensive or penitential significance is 
emphasized much more than in conversion symptoms. The danger from which 
the person tries to protect himself is less in the nature of external loss of love or 
castration; it is rather a threat from within. What is mainly feared is a kind of 
loss of self-respect or even a feeling of ‘^annihilation”; in other words, guilt feel- 
ings have a more decisive significance as the motive for the pathogenic defense. 
This is consonant with the fact that compulsion neuroses in children start later 
than hysterias, usually in the latency period. 

In certain cases it is obvious that compulsions stand for superego commands. 
A patient with a washing compulsion, feeling the command “Go and wash 
yourself,” simply repeats what he once heard as a child. It is of no importance 
that actually the parents gave this command for the sake of physical cleanliness, 
whereas the compulsion neurotic uses it as a defense against “dirty thoughts”; 
for as a child the patient felt that if the parents knew about his dirty thoughts, 
they would tell him to wash. 

The same holds true of compulsions that are not felt as positive commands 
but rather as threats. The patient has obsessive ideas about what would happen 
if he yielded to the temptation. For example: “If you do this or omit that, you 
will die”; or: “If you do this or omit that, you will have to do this or that pen- 
ance”; or: “If you do this or omit that, your father will die.” In analysis, it turns 
out that the actions that have to be counteracted or avoided have an objectionable 
instinctual significance; as a rule they represent the tendencies of the Oedipus 
complex, distorted, it is true, in a very characteristic way. The threatening pun- 
ishments mean either the danger that once was believed to be connected with 
the forbidden instinct (castration or loss of love) or some active self-punishment 
that should ward off (and substitute for) castration or loss of love. The threat 
“Or your father will die,” which does not fit this interpretation, can be explained 
as a sudden awareness of the “anxiety signal.” It means: “What you are intend- 
ing to do is not a harmless thing; the truth is that you want to kill your father; 
if you give in to the temptation at hand, the murder of your father might be the 
outcome.” 

Whereas some compulsive symptoms are distorted modes of perceiving in- 
stinctual demands and others express^ the anti-instinctual threats of the superego, 
still other symptoms obviously show the struggle between the two. Most of the 
symptoms of obsessive doubt can be covered by the formula : “May I be naughty, 
or must I be good?” Sometimes a symptom consists of two phases, one represent- 
ing an objectionable impulse, the other the defense against it. Freud's “rat-man,” 
for instance, felt compelled to remove a stone from the road because it might 
hurt somebody, and then felt compelled to put it back again (567) . In discussing 
the mechanisms of “undoing,” occurrences of this kind were mentioned {see 

pp.i53ff.). 



OBSESSION AND COMPULSION 


271 


Sometimes it can be observed how, in the course of a compulsion neurosis, a 
symptom may change its significance. A symptom that first expressed the de- 
fense may become more and more an expression of the returning original im- 
pulse. 

A patient was able to dispel an anxiety which appeared after masturbation by 
tightening the muscles of his legs. This tension was later replaced by a rhythmic 
pounding on the legs, and still later by another masturbatory act. Another patient 
felt remorseful after taking gymnastic exercises. Analysis showed that the exer- 
cises represented masturbation. Then this remorse, with which he had come to 
terms in an obsessional manner, finally made him think: “Now masturbate, and 
ruin yourself completely!” and he was compelled to masturbate several times in 
succession without any pleasure. 

Patients who have to reassure themselves that they have turned off the gas jet 
are often compelled to touch the jet again, so that the act which was intended to 
ward off the danger actually might precipitate it. A patient again and again had 
to rearrange the objects on top of a bookcase to keep them from falling on some- 
one’s head, thus giving them a real chance to fall. To protect their dear ones from 
their hostile impulses, many compulsion neurotics guard them against imaginary 
dangers so devotedly that in reality they torment them, expressing the hostility in 
spite of themselves. 

The climax of a “returning of the warded off” is represented by a woman pa- 
tient observed by Waterman. She suffered from so extreme a phobia against dirt 
that she remained in bed all day when she had the feeling that her clothing or 
the room in general was dirty. Her fear of dirt, on these days, would prevent her 
from leaving her bed at all, with the result that eventually she arrived at the point 
where she actually did soil the bed. 

Thoughts like “Now you have ruined yourself by exercise, thus it serves you 
right if you ruin yourself entirely by masturbation” indicate how to explain 
the paradox that an instinctual content may be experienced as if it were a super- 
ego command. Symptoms of this kind represent a compromise between the 
warded-off drive and the threatening superego; the drive expresses itself by the 
ideational content, the superego by the commanding form into which the origi- 
nal impulse has been distorted. Pleasureless compulsive masturbation represents 
the peak of this kind of condensation. An apparent sexual act is performed not 
for the sake of sexual pleasure but for the purpose of punishment and the sup- 
pression of sexuality. This is frequently the end result of a long development; 
a compulsion, which was a defense against masturbation, is replaced, through 
a return of the repressed, by another masturbation which now has a compulsive 
and punitive character. The “Midas” punishment through spiteful pseudo wish 
fulfillment {see p. 221) is characteristic for many compulsion neurotics. Occasion- 
ally, compulsion neurotics will put an end to a state of doubt and hairsplitting by 
masturbating. 

A similar development is frequent in regard to “masturbatory equivalents.** 



272 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

Compulsions such as knocking or ceremonial muscular movements, or rituals 
prescribing the mode in which things must or must not be touched, were first 
directed against masturbation, but may have turned into equivalents of mas- 
turbation. Sometimes the patient, in some vague way, is aware of this connection, 
and has in turn to punish himself for his “naughty" compulsive behavior. At 
other times, the patient has no inkling of the meaning of his symptom (357? 4^7? 

733 )- 

Compulsive rituals generally represent a caricature of masturbation (503). 
Sometimes a symptom which apparently has no connection with masturbation 
reveals such a connection when analyzed. A patient was forced to count up to 
five or six whenever she turned on a faucet or even passed a faucet. She w'as com- 
pletely dominated by penis envy, so it could be expected that a symptom related 
to a water faucet would have some connection with her penis envy. Actually, she 
remembered that once, when her finger was infected, her mother had frightened 
her by telling her that the finger would have to be cut ofi. Thus the ritual was to 
be interpreted as follows. The sight of the faucet (of a penis) forced the patient 
to convince herself that she had not four but five or even six fingers. Later in 
analysis, it turned out that the ritual had a closer connection with masturbation; 
she used to masturbate by holding her finger in front of her genitals and letting 
the urine flow along it as if the finger were a penis. 

The Oedipus complex often can be seen as the center of the warded-off im- 
pulses, sometimes even on cursory examination, which, in hysteria, repression 
would render entirely impossible. 

A patient, unfortunately not analyzed, complained of two types of obsessive im- 
pulses. Whenever he saw a woman he was compelled to think: I could kill that 
woman"; and whenever he saw knives or scissors he would think: “I might cut 
off my penis." The first of these two impulses originally had been expressed in 
the form “I could kill my mother"; its extension to other women was already a 
distortion by means of generalization. The patient lived a lonely life, and his only 
sexual outlet consisted in wet dreams in which he saw himself strangling women 
or killing them by some other method. Thus his impulse to murder women 
was a distorted expression of his incestuous desire. Eliminating this distor- 
tion, it can be stated that the patient suffered from two impulses: to attack his 
mother sexually and to chop off his penis. Now his impulses can be understood 
as a biphasic symptom: the first half represents the gratification of the Oedipus 
wish, the second half the punishment the patient dreaded. 

Unintelligible symptoms become intelligible when their history is studied. 
The original form in which they first appeared is closer to the unconscious mean- 
ing. A symptom may be an allusion to some event in the patient’s past; this illu- 
sion cannot be understood $0 long as the whole context is not known. 

Before going to bed, a patient was compelled to spend a long time repeatedly 
opening and closing the window. That symptom first appeared when, as -an 
adolescent, he and his roommate would fight as to whether the window should 



OBSESSION AND COMPULSION 


273 


be opened or closed. Thus the later compulsion meant; “Which of us will win? 
Which of us is the stronger?” With this formula as a starting point, it eventually 
became clear that the patient’s problem was mobilized by the homosexual tempta- 
tion involved in sharing the same room with his friend. The real question was 
whether he should compete with men as a man or resign himself to complying 
with their wishes in a passive, submissive, feminine way. This proved to be the 
conflict in which his compulsion neurosis was rooted. 


REGRESSION IN COMPULSION NEUROSIS 

The example given above of the open expression of the Oedipus wishes, in 
which the patient felt the two impulses of killing women and cutting off his 
penis, is typical of the manner in which incestuous wishes are distorted in com- 
pulsion neuroses. The patient talks about “killing * his mother, when he actually 
means having sexual intercourse with her. The patient’s sexual dreams were evi- 
dently sadistic in nature. Thus not only was an infantile attachment to the 
mother operative, but specifically a sadistic distortion of this attachment. 

Overt or concealed tendencies toward cruelty, or reaction formations against 
them, are constant findings in compulsion neuroses. With equal constancy anal- 
erotic impulses and defenses against them are found in the most varied forms. 
This constant association of traits of cruelty and of anal eroticism in compulsion 
neuroses, to which Jones first drew attention (879), was what convinced Freud 
of the close relationship of these two types of phenomena, and of the existence 
of an “anal-sadistic” stage of libido organization (581). 

In hysteria, the repressed ideas remain unaltered in the unconscious and con- 
tinue to exert their influence from there. In so far as the Oedipus complex is the 
basis of compulsive symptoms, too, this also holds true for compulsion neurosis; 
but here, in addition to the Oedipus complex, very strong anal and sadistic im- 
pulses, which originated in the preceding period, regularly are operative and 
combated. The anal-sadistic instinctual orientation of the compulsion neurotic 
can, as a rule, be easily recognized, in the clinical picture, once attention has been 
directed to this point. Compulsion neurotics are generally and obviously con- 
cerned about conflicts between aggressiveness and submissiveness, cruelty and 
gentleness, dirtiness and cleanliness, disorder and order. These conflicts may be 
expressed in the external appearance and the manifest behavior, whereas ques- 
tions concerning sexual life are characteristically answered: “So far as that goes, 
everything is in order.” The physiological functions seem to be in order because 
they are isolated from their psychological content; the physiological discharge in 
the patients’ sexual activities is not an adequate discharge for the sexual tension 
which is really expressed in their ideas about cruelty or dirt. Sometimes the anal- 
sadistic orientation reveals itself in the form of reaction formations only, like 
ovcrcompcnsatory kindness, an exaggerated sense of justice or cleanliness, an 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


274 

incapacity for any aggression, punctiliousness in all matters relating to money. 
Mixtures of reaction formations and direct anal or sadistic outbreaks may make 
the patient’s behavior appear contradictory. The patients are simultaneously or- 
derly yet disorderly, neat yet dirty, kind yet cruel. 

A patient, who was not analyzed, complained in the first interview that he suf- 
fered from the compulsion to look backward constantly, from fear that he might 
have overlooked something important behind him. These ideas were predomi- 
nant: he might overlook a coin lying on the ground; he might have injured an 
insect by stepping on it; or an insect might have fallen on its back and need his 
help. The patient was also afraid of touching anything, and whenever he had 
touched an object he had to convince himself that he had not destroyed it. He had 
no vocation because the severe compulsions disturbed all his working activity; 
however, he had one passion: housecleaning. He liked to visit his neighbors and 
clean their houses, just for fun. Another symptom was described by the patient 
as his “clothes consciousness”; he was constantly preoccupied with the question 
whether or not his suit fitted. He, too, stated that sexuality did not play an impor- 
tant part in his life. He had sexual intercourse two or three times a year only, and 
exclusively with girls in whom he had no personal interest. Later on, he men- 
tioned another symptom. As a child, he had felt his mother to be disgusting and 
had been terribly afraid of touching her. There was no real reason whatsoever for 
such a disgust, for the mother had been a nice and popular person. 

This clinical picture shows that the patient’s sex life was oriented anal-sadis- 
tically, and that incestuous fear was the basis for this distortion. 

In analysis, the anal-sadistic orientation of compulsion neurotics becomes, of 
course, still much clearer. All compulsion neurotics, Freud stated, have “secret 
scatologic rituals” (555) which are partly anal-erotic games, partly reaction for- 
mations against such games, and partly both at once. W. C, Menninger has col- 
lated the most typical and frequent types of scatologic rituals (1143). The pa- 
tients are always on guard against unconscious anal tendencies mixed with 
hostilities— for instance, against a drive to play “dirty tricks” on their fellow 
men. 

Thus Freud stated that the instinctual organization of the compulsion neurotic 
resembled that of the child in the anal-sadistic phase of development. This 
seems to contradict the typical observation that the compulsion neurotics are 
engaged in a defensive struggle against the Oedipus complex, the climax of 
which is not supposed to be reached before the phallic period. Another apparent 
contradiction lies in the fact that in spite of the anal sadism, many compulsions 
are closely related to genital masturbation. 

The explanation of these apparent contradictions is to be found in the con- 
cept of regression. One gets the impression that the anal-sadistic impulses grew 
at the expense of the original phallic Oedipus impulses; the genital Oedipus 
impulses decreased in strength as the anal-sadistic impulses increased. The pa- 



OBSESSION AND COMPULSION 275 

tient, in attempting to ward off his Oedipus complex, regressed, in part, to the 
anal-sadistic level (567, 581, 596, 618). 

However, the compulsion neurotic is no coprophiliac. Since his anal-sadistic 
impulses, too, are intolerable, or because in regressing to them the offensive 
element of the Oedipus complex was not entirely eliminated, the patient has to 
continue his defensive fight against the anal-sadistic impulses. The interpola- 
tion of regression complicates the picture of compulsion neurosis as compared 
with hysteria. 

Freud’s theory that regression to the anal-sadistic level forms the cornerstone 
in the construction of compulsion neurosis can explain many facts that other- 
wise would be contradictory. 

That the warded-off impulses in compulsion neurosis are composed of phallic 
Oedipus tendencies and genital masturbatory impulses on the one hand and 
nevertheless are anal-sadistic in nature on the other is now comprehensible. The 
defense was first directed against the phallic Oedipus complex and supplanted it 
with anal sadism; then the defense continued against the anal impulses. 

Occasionally analysis can show the actual process of regression and can prove 
that the compulsion neurosis came into being after it. 

A girl suffered from the obsessive fear that a snake might emerge from the 
toilet and crawl into her anus. In analysis it turned out that this fear had had 
a forerunner: the first anxiety had been that the snake might be in her bed. To 
protect her from the phallic anxiety, a regression had taken place; the location of 
the fear was changed from the bed to the toilet, from genitds to anus. 

A boy, still in the period of latency, was seized by an overpowering anxiety 
whenever he had an erection. He stated that he was afraid that he might injure 
his penis. He developed the habit of masturbating whenever he had an erection 
in order to get rid of it. This, however, created new anxieties. Later on, he de- 
veloped the urge to urinate and to defecate very frequently. After this, he devel- 
oped an extensive compulsion neurosis. It is evident that the genital impulses at 
first incessantly asserted themselves in spite of the menacing fear of castration, 
that they were then replaced by pregenital strivings, and that only after the re- 
gression to anal eroticism did the compulsion neurosis make its appearance. 

A more indirect but almost experimental proof for the anal-sadistic regression 
in the etiology of compulsion neurosis is furnished by the rare cases in which a 
hysteria after a relinquishment of genitality is replaced by a compulsion neu- 
rosis. Freud observed this process in a woman who, owing to external circum- 
stances, ceased to place any value on her genital sexual life (581). Something 
similar frequently can be observed after the climacterium, when organic factors 
have'ffrovoked a regression. 

The operation of regression can also be proven by cases in which it fails in its 
defensive purpose. Though shifting his interest to the anal field, the patient, in 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


276 

such cases, does not succeed in avoiding castration fear. Instead he develops what 
might be called an anal castration fear. An otherwise compulsive patient may be- 
come incapable of defecating except in small or unformed masses, thus trying 
to avoid the danger of “losing an organ.” The material treated by Freud under 
the heading of the symbolic equation feces = penis (563, 593) owes its origin in 
part to this regression. 

Some of the typical fears relating to the toilet in children and in compulsion 
neurotics, such as fear of falling into the toilet bowl or of being eaten up by some 
monster coming from it or the rationalized fear of being infected there, prove in 
analysis to refer to castration anxiety. They are regressive distortions of the fear 
of castration. A child whose various fears could be traced back to a terror of seeing 
that his feces had disappeared expressed the fear that his penis might disappear 
in the same manner. 

As in oral fears, the fact that anal fears cover castration anxieties does not 
contradict the autonomous nature of pregenital fears. This distortion of castra- 
tion anxiety is a regressive one, formed by the remobilization of the old pregenital 
anxiety over the loss of feces. It is often very difficult to determine which fraction 
of an anal anxiety represents a vestige of original pregenital anxiety, perhaps con- 
tributing a certain quality to the castration fear right from the beginning (the 
pregenital experiences of parting with the breast and with the fecal masses are 
archaic forerunners of the idea of castration) (36, 1466), and which fraction is 
rcgressively distorted castration anxiety. 

It is an ever recurrent source of surprise to find that, after analysis has uncov- 
ered a whole anal-sadistic world dating back to very early years of childhood, 
completely repressed memories appear of a still earlier period, purely phallic in 
orientation, which had been shattered by castration anxiety. It is important not 
to be misled into thinking that newly appearing memories with reference to 
anal-sadistic impulses are memories from the time of the original anal-sadistic 
organization. Very often they are not original but regressive in nature; they 
came after the phallic Oedipus complex; and the original pregenital organiza- 
tion must be dated still earlier. 

Clinical material in which ideas and modes of behavior appropriate to the 
genital level are found intermingled with anal-sadistic material is abundant. 
Certain compulsion neurotics, for example, perceive sexuality in anal terms only, 
as if it were a bathroom affair; others regard sex as a financial matter— which 
may be expressed, for example, by prostitution fantasies— or as a matter of prop- 
erty. A man may lay much stress on retaining his semen in intercourse as long 
as possible, sometimes with the idea of increasing the foreplcasure, sometimes 
with the idea of “preserving” the semen, sometimes rationalized as consideration 
of the woman’s feelings; analysis shows that he does with his semen what he 
previously had done with his feces. In still other cases, the sadistic distortion of 
the entire sexual life is more in the foreground than the anal one. For certain 



OBSESSION AND COMPULSION 


277 

compulsion neurotics sexual intercourse unconsciously means a fight in which 
a victor castrates a victim. Men patients of this kind may have no other interest 
in sex than to get the reassuring proof that they are not the victim (it seems that 
they never can achieve a full reassurance); women patients may develop long- 
ings to look at male genitals or to touch them, in which concealed expressions 
of destructive wishes are manifested. 

The immediate effect of regression is twofold: the enhanced sadism combines 
with the Oedipus hostility felt for the parent of the same sex and imposes new 
defensive tasks on the ego; and the emergent anal eroticism changes the sexual 
aims and, in this way, the behavior of the person. Anal eroticism, it has been 
stated, is always bisexual in nature,' the anus being simultaneously an active ex- 
pelling organ and a hollow organ which may be stimulated by some object en- 
tering it (see p. 67). Vacillation between the original masculine attitude, now 
reinforced and exaggerated by the active-sadistic component of anal eroticism, 
and the feminine attitude represented by the passive component of anal eroti- 
cism (163) forms the most typical conflict in the unconscious of the male com- 
pulsion neurotic. The phallic Oedipus attitude is inhibited by the idea that grati- 
fication means the loss of the penis. The regression imposes a feminine attitude, 
yet does not entirely destroy the original masculine one. 

The simultaneous emphasis on the opposite ideals of independence and sub- 
mission in modern education increases the conflict between active-masculine and 
passive-feminine strivings in compulsion neurotics. This conflict may assume 
various forms. Superficial activity may be stressed as a reaction formation against 
deeper passivity and vice versa. In many ways an actual passivity may become 
rationalized as an activity. A normal compromise of this kind is the identification 
love of the boy for his father; by being temporarily feminine toward him he gets 
a promise of future participation in his masculinity. This “psychology of the pu- 
pil,” passive toward the master for the purpose of later becoming master himself, 
is open to several pathological distortions (see p. 89). 

The aim of the feminine wishes of male compulsion neurotics is not, of course, 
to be castrated; it is rather the wish for something to be inserted or retained in 
the body. The idea that this wish, too, is not a reliable protection against castra- 
tion, that castration may even be a prerequisite for its gratification, causes the 
most intense anxiety, which in turn furnishes the motive for further defense. 
This was the state of affairs in the wolf-man, who repressed his inverted Oedi- 
pus complex because of castration anxiety. His fear of being eaten by the wolf 
expressed both his feminine wishes toward his father and his castration anxiety 
connected with them (599). 

In this way, all sexual gratification may become so cemented with fearful 
ideas of castration that finally the one becomes inconceivable without the other. 
Often the patient behaves as if he unconsciously sought castration, but what he 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


278 

actually is searching for is something that will bring an end to the anxiety that 
prohibits his pleasure. The “castration” actually sought is either a castration sym- 
bol only, a lesser evil which the patient is ready to suffer in order to avoid full 
castration, or it is an active anticipation of what he otherwise would have to 
endure passively. Frequently, after the patient has carried out some activity that 
symbolizes castration, he goes through a ritual that stands for its “undoing.” 

Like bisexuality, ambivalence is a characteristic of increased anal eroticism. 
A marked ambivalence of the object relationships is typical of the pregenital 
stages of libidinal development; it reappears when the genital organization is 
given up again. In so far as an anal fixation is a precondition of the anal regres- 
sion, the two qualities associated with it, bisexuality and ambivalence, can be 
looked upon as a precondition of the regression. But in so far as the regression in- 
tensifies and makes persistent the anal-sadistic orientation, bisexuality and am- 
bivalence, being attributes of this orientation, are results of the regression. 

In conversion hysteria with intestinal symptoms, the anal regression is limited 
to the choice of the afflicted organ that is used for expressing genital fantasies. 
This is different in compulsion neurosis. Here a full regression to the world of 
anal-erotic wishes and attitudes takes place and changes the total behavior. Fre- 
quently even the olfactory orientation characteristic of anal-erotic children and 
lost in normal adults comes back in compulsion neurotics (202). Often the re- 
gression also brings more or less narcissistic features to the fore, the increased 
bisexuality giving opportunity for fantasies about intercourse with oneself. 
There are transitional states between compulsion neuroses and manic-depressive 
psychoses or schizophrenias. 


DIGRESSION ABOUT THE ANAL CHARACTER 

Freud discovered that certain character traits are preponderant in persons 
whose instinctual life is anally oriented (563). These traits are partly reaction 
formations against anal-erotic activities and partly sublimations of them. The 
main traits o{ this kind are orderliness, frugality, and obstinacy. Actually, per- 
sons falling ill with compulsion neurosis regularly show an intensification of 
these trends. Therefore it is necessary to discuss them at this point. 

The training for cleanliness in infancy is of great importance for the develop- 
ment of the relation between the child’s ego and his instinctual drives. This train- 
ing is the first situation in which the child may or may not learn to postpone or 
renounce a direct instinctual gratification out of consideration for the environ- 
ment. On this occasion, the child acquires the active mastery of decisive instinc- 
tual demands; but simultaneously the hitherto “omnipotent” adult becomes de- 
pendent, to a certain degree, on the will of the child {see pp. 67 and 487 f.). 

The anal character traits formed in the conflicts around this training have in 



OBSESSION AND COMPULSION 279 

part qualities of resistance offered by the instinct to the demands of the environ- 
ment, in part qualities of obedience to them, and in large part form compromises 
between these two trends (21, 194, 883, 1143). 

Frugality is a continuation of the anal habit of retention, sometimes motivated 
more by the fear of losing, sometimes more by erogenous pleasure. Orderliness 
and obstinacy are more complicated. Orderliness is an elaboration of the obe- 
dience to, obstinacy of the rebellion against the environmental requirements 
covering the regulation of excretory functions. Under certain (constitutional 
and environmental) circumstances, obstinacy may become so extreme that the 
person in question is compelled always to do the exact opposite of what is re- 
quired of him. 

A compulsion neurotic patient used to sleep during the day and remain awake 
all night because “he could not see the point” of doing the customary thing. This 
obstinacy, however, was rather a kind of “rationalization” of a neurotic difficulty 
due to the dammed-up state of this patient’s libido. 

The word obstinacy {ob-stinare) itself expresses the idea “to hold one’s posi- 
tion in spite of somebody.” Originally, stubbornness meant only resistance, to 
pit one’s will against somebody else’s; later, it meant pitting one’s own will 
against superior inimical forces; still later (because the inimical forces are su- 
perior), getting one’s way indirectly, not through force but through guile, in 
a mode wherein the weak one may be unexpectedly strong. Stubbornness is a 
passive type of aggressiveness, developed where activity is impossible. This oc- 
curs for the first time in a child’s life when he is able to spite the grownups’ 
efforts by tightening his sphincters. Still later, the “power of the powerless” may 
be not of a real but only of a magical nature; and then a kind of “moral” supe- 
riority may replace the “magical” superiority. The entrance of the moral factor 
into the picture shows that the superego plays a decisive part in the later devel- 
opment of stubbornness. The same means a child applies to resist the superior 
forces of his educators he may apply later in his fight against his own superego. 
What is usually called stubbornness in the behavior of adult persons is an at- 
tempt to use other persons as instruments in the struggle with the superego. By 
provoking people to be unjust, they strive for a feeling of moral superiority which 
is needed to increase their self-esteem as a counterbalance against the pressure of 
the superego (1202). 

The moral superiority may be experienced either through the feeling of being 
unfairly treated itself or through making the “unfair” adult sorry afterward, 
which should enforce affection from him. 

In other words, stubbornness, initially the combative method of the weak, later 
becomes the habitual combative method in the struggle for the maintenance or 
the restoration of self-esteem. Stubborn persons are filled with narcissistic needs, 



28 o 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


whose gratification is required to contradict some anxiety or guilt feeling. Hence 
it must be concluded that stubbornness has an oral basis, too. However, it is de- 
cisively anchored in the anal stage and developed through experiences gained 
during the period of training for cleanliness. Persons who are afraid of being 
trapped, misused, and cheated of their narcissistic supplies are understandably 
more inclined to become stubborn. Frequently a tendency to keep open a line 
of escape determines stubborn behavior (444). 

The objection has been raised that stubbornness may be acquired in social 
conflicts between the child and his environment during the training for cleanli- 
ness but that this does not necessarily mean that obstinacy is anal in nature 
(921, 1022) . This argument does not take into account the findings of psycho- 
analysis, which show that the counterforces against the instincts are built up by 
the energies of the instinctual forces themselves which, under the influence of 
the environment, have changed their direction. The psychoanalysis of stubborn 
persons provides abundant proof that stubbornness is connected with anal sensa- 
tions and gives an anal-erogenous pleasure (17, 21, 555, 563, 567, 593, 878, 1202, 

1634)- 

The character trait of orderliness represents the elaboration of obedience. Ti- 
diness, punctuality, meticulosity, propriety, all signify a displacement of the 
compliance with the environmental requirements in regard to defecation. In 
compulsion neurotics, the anal character traits, representing obedience, reveal 
themselves as reaction formations. The basic opposite mode of behavior breaks 
through or permeates them only too readily. It is the paragon of punctuality 
who in many instances is surprisingly unpunctual, the cleanest person who is in 
some curious respect astonishingly dirty. Abraham reported a number of such 
points of anchorage in the character of a perpetual struggle with the counter- 
cathexis: for example, persons who are scrupulously neat in regard to their top 
clothing and as much untidy in regard to their underclothes; others who keep 
their belongings in a very disorderly fashion but who from time to time must 
clear everything up, a practice that corresponds to the autoerotic habit of 
retaining feces for a long while and then ‘‘settling everything at once” (21). 

Certain anal traits of character represent a diversion of the instinct by the ego, 
either to a new aim or to a new object. If this succeeds it may be called a sublima- 
tion. In compulsion neurotics it does not succeed, and the “displaced” activities 
become the scene of the same defensive struggle around frugality, stubborn- 
ness, and orderliness as were the original anal impulses. There are displacements 
of interest from the product, and others from the process of defecation. 

Concerning the first ones, Freud has shown that the substitutes have a very 
complex relationship to the original (593). The connections of the concept of 
feces with the more genital ideas of penis and child are of less importance for 



OBSESSION AND COMPULSION 281 

the psychology of compulsion neurotics than are those with the ideas of gift, 
money, and time. 

To understand the relation between feces and money, operative in every com- 
pulsion neurotic, it is first necessary to have an understanding of the psychologi- 
cal significance of the concept of possession (21). The child learns to differentiate 
between ego and nonego, but this is a long and complicated process. In its 
course, the child passes the stage that Freud has called the purified pleasure ego 
(588) : everything that gives pleasure is perceived as ego, everything that brings 
pain as nonego. The original basis of this classification is the idea: “Everything 
that is pleasurable I should like to put into my mouth and swallow; everything 
that is painful I should like to spit out” (616). But there are pleasurable things 
that cannot be taken into the mouth. Those things are, sooner or later, called 
“mine,” and that means: “I should like to take them into my mouth, but I can- 
not do so; I declare them as ‘symbolically-put-into-my-mouth.*” When the child 
realizes that he loses his feces, which represent to him a very precious substance, 
a part of his own body, he feels : “This is something that ought to be in my body; 
but it is outside now, and I cannot put it back.” Again, he calls it “mine,” which 
means: “I should like to have it inside my body, but that is impossible; so I de- 
clare it ‘symbolically-put-into-my-body.’ ” Thus “possession” means “things that 
do not actually belong to the ego, but that ought to; things that are actually out- 
side but symbolically inside.” Though they are in the external world, they are 
cathected with “ego quality.” Possessions, as a rule, are provided with attributes 
for the purpose of identifying them : “The blue one belongs to me.” This, how- 
ever, is not easily done with feces, which look the same in all human beings. 
Later on, the child learns that “money” exists, something which grownups es- 
teem as a possession but which is not “blue” but always looks alike, no matter 
in whose possession. What money and feces have in common is the fact that they 
are deindividualized possessions; and deindividualized means necessarily losa- 
ble. Thus money, in the same way as was feces previously, is estimated and 
watched over as a possession which is in constant danger of losing its ego quality. 
Both substances, in spite of their high evaluation, arc regarded with contempt 
because of their deindividualized, monotonous, unspecific nature. Actually anal- 
erotic persons who love money, love money that i&^not deindividualized; they 
love gold and shining coins or new bills, money that has still a “blue,” individual- 
ized character, Ferenezi, in studying the paths of displacement that lead from 
feces to money, showed that shining things and stones are liked earlier than 
uncolored sand, and eventually money is accepted as a substitute (466). When 
this path of “sublimation” is disturbed because the old instinctual wishes refer- 
ring to feces still determine the attitude toward money, the attitudes toward 
money become irrational. Money then becomes an object for pleasure (or for 



282 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


punishment), that is, a substitute for feces rather than an objectively useful thing. 
It may be irrationally retained or irrationally thrown away (15) or these two 
contrasting behaviors may be combined in various ways (480) . 

Anal personalities are as disturbed in their attitude toward time as they are in 
their attitude toward money : in respect to time, too, they may be stingy or prodi- 
gal or both alternately; they may be punctual or unpunctual; they may some- 
times be accurate to the fraction of a minute, and at other times grossly unre- 
liable. 

Abraham’s statement that “patients often save time in small amounts and 
squander it in large ones” (21) was clearly exemplified in a case observed by 
Garma. The patient was a man who had no occupation but spent his time in neu- 
rotic activities and hour-long daydreams. Whenever he wished to leave home, he 
would open a window to watch for the suburban train to the city. When he heard 
the train, he would call his maid, who would then open the door, holding his coat 
in readiness for him. The patient would seize the coat, rush down the steps to the 
station across the way, and catch the train just as it was pulling out. The whole 
procedure was a simple repetition of his childhood habit of waiting till the last 
moment before going to the bathroom. 

In compulsion neuroses the regression has turned the patient’s relation to 
time, like his relation to money, into an arena wherein his instinctual conflicts 
arc fought out. Sometimes one may follow a false lead in looking for object- 
libidinal conflicts in irrational, compulsive behavior toward time. To a large 
extent this behavior may represent a form of autoeroticism. Some compulsion 
neurotics are tardy not because they want to irritate the person who is expecting 
them but because the suspension of activity gives them the same autoerotic ten- 
sion and pleasure which, as children, they enjoyed while retaining their feces. 

The reconstruction of the genetic relation between time and feces is not as 
easy as that between money and feces. Harnik has collated a good deal of an- 
thropological data which show that the awareness of the flow of time, especially 
the ability to measure time, unconsciously is deeply rooted in anal eroticism 
(738) . How often defecation has to take place, at what intervals it has to be done, 
how long the process itself should take, how long it may be successfully post- 
poned, and so on, are the situations in which the child acquires the ideas of order 
and disorder regarding time, and of measurement of time in general. 

These remarks are not intended to mean that the concept of time is gained in 
anal-erotic experiences exclusively. A much more basic role in this respect is 
played by kinesthetic sensations which convey internal biological rhythms within 
the body (breathing, pulse) (172, 1455)* Anal experiences are of more impor- 
tance for the measurement of time and for the development of schedules as a 
means of mastering reality (738, 1193). Neurotic disturbances in the subjective 
experience of the course of time actually oedur more often in cases with uncon- 
scious conflicts around the eroticism of depth sensibility and equilibrium, whereas 



OBSESSION AND COMPULSION 


283 

neurotic disturbances in the practical use of time and time systems as protections 
against unforeseen events are more characteristic for typical compulsion neuroses 
with unconscious anal-sadistic conflicts (338, 1385). 

The childhood attitude toward feces is often found transplanted into the 
later attitude toward the individuars personal achievements. A person may 
have a self-satisfied admiration for what he has done, or he may be discontented 
with all his achievements, or he may vacillate undecidedly between these two 
extremes, according to the outcome of his anal-instinctual conflicts. 

A patient’s tendency toward ruthless self-criticism was traced back to her third 
year of life, when she was afflicted by an intestinal illness that made her inconti- 
nent after she had already been trained in toilet habits. From this time on, she was 
convinced that she could produce nothing properly. Another patient, an author, 
dreamed of the galley proofs of her book being squeezed out of a small opening. 

The anal retention, which always contains the two components, fear of loss 
and enjoyment of a new erogenous pleasure, may also be displaced to another 
object. Cupidity and collecting mania, as well as prodigality, have their cor- 
relating determinants in the infantile attitude toward feces. 

As sublimations concerning the product of defecation may fail if anal eroti- 
cism is retained, sublimations concerning the function may fail, too. If reaction 
formations are at work instead of sublimations, painting, for instance, may have 
retained the unconscious meaning of anal smearing, which leads either to the 
failure of the person as an artist or, if the ego, recognizing the forbidden impulse, 
enters a protest, to an inhibition of the ability to paint. The displacement of ca- 
thexes from defecation to speech and to thinking activities is sometimes betrayed 
by irrational modes of retaining or expelling words or thoughts; it can be seen 
in inhibitions of these functions as well as in their irrational hypercathexis. 

In addition, the behavior of anal personalities is pervaded by manifestations of 
the sadism that is always simultaneously present or of reaction formations against 
sadism. The fact that the child in retention finds narcissistic satisfaction in his 
ability to control the sphincters also forms a point of departure for sublimations 
or reaction formations. A strong desire for power may be derived from the sense 
of power that accompanies the control of the sphincters. The power desired may 
be obtained through self-control or through the control of other persons, and 
the longing for this power in general is determined by the fear of losing self- 
esteem. 

Many other conflicts, once connected with anal eroticism, may be reactivated 
in compulsion neurotics. The renunciation of pleasure in consideration of ob- 
jects, whether through love or fear of them, is the main achievement of the 
training for cleanliness. The individual learns to give, whereas during the oral 
period his interest was mainly in receiving. Disturbances during this period. 



284 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


therefore, occasion subsequent disturbances in relation to objects, so that no 
equilibrium can be reached between giving and taking. 

Abraham’s classic description (21) also attributed a number of less funda- 
mental traits to conflicts around anal eroticism: the tendency, for example, to 
look at everything “from the rear” (which is the basis of many compulsive symp- 
toms) ; the fear of “starting” which causes the beginning of all new activities to 
be postponed as long as possible, although once started, an interruption is diffi- 
cult ; the tendency to have others do everything for one, if enemas figured in the 
history of infantile anality, and the tendency to decide everything for oneself, if 
demands for anal regularity had been met with protest in childhood; the tend- 
ency to do many things all at the same time for the purpose of “saving time,” 
which depends on autoerotic games played while defecating, often continued as 
a compulsion to read while sitting on the toilet, which means to regain material 
while other material is lost. 

This description of anal character traits extends beyond the field of compulsion 
neurosis, and we shall have to come back to it when discussing character anoma- 
lies (see pp. 487 f.) . However, these traits are characteristic for the typical compul- 
sion neurotic. No compulsion neurotic can handle money and time rationally, 
though the difficulties manifested may vary greatly in nature and intensity. 


COMPULSIVE SYSTEMS , 

“Orderliness,” which has been used as a protective measure against dangerous 
instinctual demands in the original anal-erotic period, regains this protective 
function in a subsequent compulsion neurosis. The compulsion neurotic who is 
threatened by a rebellion of his (regressively distorted) sensual and hostile de- 
mands feels protected as long as he behaves in an “orderly” manner, especially 
concerning money and time. The unconscious anal-sadistic drives, however, 
usually sabotage orderliness and clinging to a “system.” They reappear in the 
form of disorder or events that disturb the system, or they may permeate even 
the orderly syndrome itself. 

Lucille Dooley, in an interesting paper, collated material concerning orderli- 
ness and systems in regard to time, clung to by compulsion neurotics for whom 
any disturbance of “routine” unconsciously means murder and incest (338). 
Many compulsion neurotics have an exaggerated interest in all kinds of time- 
tables. They may even regulate their entire life according to systematized time- 
tables. As long as the timetable functions as the regulator of their activities, they 
are sure that they are not committing the sins they are unconsciously afraid of; 
and as long as they know beforehand what they will do afterward, they are able 
to overcome their fear that their own excitement may induce them to do things 
they arc afraid of. 



OBSESSION AND COMPULSION 


285 

^‘Orientation in time*^ is a typical reassuring measure. Many a fear of death 
means a fear of a state where the usual conceptions of time are invalid. States in 
which the orientation in time becomes more difficult — dusk or long evenings in 
winter or even long days in summer — are feared by many compulsion neurotics. 
However, fears of this kind may also be rooted simply in the fact that frightening 
events in childhood took place at that time of day that is feared later on (599). 

Compulsion as such is used as a similar protection; it ensures against the men- 
ace of dangerous spontaneity. Everything that is done in a compulsive way is done 
as routine, according to a prearranged plan, from which the objectionable im- 
pulses are supposed to be excluded. As long as the rules are followed, nothing 
can go wrong. However, the compulsion neurotic is aware that he has instincts 
nevertheless. He never can achieve the satisfying feeling that he is actually fol- 
lowing the rules, that enough rules are provided to govern all possibilities, and 
that he knows all the rules sufficiently. 

Things become more complicated when other persons are needed as “wit- 
nesses” as to the validity of the compulsive demands of orderliness and system. 
The patient does not only feel compelled to keep systematic order himself but 
also requires others to accept the same system. The others as a rule refuse to 
submit to his system. This increases his hostility and makes him try various 
means to compel those around him to do as he wishes; he becomes afraid of the 
hostility expressed in these attempts and this fear in turn increases his systematic 
needs, starting a vicious circle. Things become still more complicated if the sys- 
tems of different compulsion neurotics clash in such a way. And since compul- 
sion neurosis is based on increased anal eroticism, which again is partly deter- 
mined by constitution, several cases of compulsion neurosis occur frequently in 
the same family. Severe family troubles may be created in this way. 

There is a compulsion neurotic counterpart to hysterical pseudologia (437). 
Some patients find certain gross falsifications of facts compatible with their ob- 
sessive conscientiousness and exaaness, and even with an obsessive fanaticism 
for truth. Consonant with the compulsive tendency toward “displacement onto 
a little detail,” the falsifications frequently concern unimportant details only. 
The actual small modifications of truth represent more important intended ones; 
and these more important modifications serve the purpose of forcing the world 
into a definite system. The facts are supposed to be not as they are but rather as 
the obsessive system demands them to be. The falsification expresses also the 
tendency to press the same system upon others: “You are not supposed to see 
things with your own eyes but in the way I am showing them to you.” A vio- 
lence of this kind, used against his fellow men, may satisfy the compulsion neu- 
rotic’s sadism and anal obstinacy. The main aim of such behavior, however, is 
a more specific one. Freud once compared the spontaneous memories of early 
childhood with the creation of myths in which historical facts are falsified ac- 
cording to wishes (596)* In compulsive attempts td force “witnesses” to accept 



i86 xhe psychoanalytic theory of neurosis 

obsessive systems, the creation of such myths frequently can be observed directly. 

The patients’ adherence to their systems does not at all mean that they are 
able to maintain them. Once more, what has been warded off enters into the 
methods of warding off. More and more the patients may feel that the systems 
into which they would like to force the world have been violated. They may re- 
act with attempts to increase the rigidity of the systems; but they are never as- 
sured that the demands of the system are entirely fulfilled. Usually these de- 
mands ask for an isolation of things that represent unconscious trends originally 
belonging together. The patients, therefore, often see a strict either-or cleavage 
where actually an “as-well-as” relation is in effect. 

A compulsion neurotic who played chess occupied himself for hours with the 
obsessive problem whether to use more “strategy” or more tactics ; he thought 
of this only in the abstract, not in any way in a concrete situation in a concrete 
game. His either-or idea made him actually lose every game. The doubt was based 
on the unconscious doubt as to whether he should defeat his opponent or let his 
opponent defeat him, which meant whether he should assume a masculine or a 
feminine attitude. 

Related is the phenomenon which Graber has designated “neurotic typing” 
(710). Compulsion neurotics have the tendency to make false generalizations, 
to classify hastily all ideas into certain mutually exclusive categories, and then 
to get into^a state of doubt concerning the nature and evaluation of the categories. 
“I know already in which category a given phenomenon belongs” generally 
means “I do not need to be afraid of it as of a possible temptation or punish- 
ment.” The more surprising an event, the more dangerous it is. The “typing” 
tries to exclude the possibility of surprises and to falsify new events into “already 
known” things. 

To order the unknown according to known categories is the task of science. 
Compulsive systematizing, performed not for the purpose of mastering reality 
but rather in order to deny certain aspects of it, falsifying reality, is a caricature of 
science (618). 

The compulsion neurotic is ambivalent. He is so even toward his own systems 
and rules. When he takes side against his dangerous instinctual impulses, he 
needs systems and rules as protection. When he turns against his superego, he 
also turns against systems and rules imposed by the superego. He may openly 
rebel against them or he may ridicule them by tracing them ad absurdum (567). 

OTHER DEFENSE MECHANISMS IN COMPULSION NEUROSIS 

The alteration of character, typical of compulsion neurosis, is not always di- 
rectly due to regression. It is also caused by the use of other defense mechanisms 
after the regression, namely, of reaction formation, isolation, and undoing. The 



OBSESSION AND COMPULSION 


287 

use of these mechanisms, it is true, also depends on the pathognomonic regres- 
sion, because reaction formation, isolation, and undoing are applied much more 
against pregenital strivings, while repression proper is related more to genitality. 

Reaction formations become deeply imbedded into every compulsion neurot- 
ic’s personality. In fighting unconscious hostilities, the compulsion neurotic 
tends to be a gentle person in all his relationships and in a general way. This 
may bring great narcissistic satisfaction, which creates an unfortunate difficulty 
for psychoanalytic treatment. 

However, even the fixed reaction formations are rarely successful; the mind 
of the compulsive patient remains occupied with a perpetual struggle between 
reaction formation and the still-effective original impulse. 

As for isolation and undoing, their appearance in compulsive symptoms was 
described previously (see pp. 153-159)* 

A few more examples of typical isolation may be added. A patient with ob- 
sessive doubts found it very difficult to comply with the analytic procedure, pro- 
testing strongly against the basic rule of free association. It turned out that he did 
so because he attempted to keep secret the existence of a certain girl friend — not 
because he did not wish to speak of this matter at all, nor yet because he did not 
wish to expose the particular person, but because in his analysis he had spoken 
of masturbation, and he wished to keep her image isolated from everything that 
had to do with masturbation. He felt that he would be able to speak about her 
if he were only sure that he would not think of masturbation during the same 
session. Later in analysis it became clear how unsuccessful this isolation was; a 
compulsive symptom which the patient regarded most anxiously and took the 
most pains to conceal was that whenever he saw the girl in question or heard her 
name, he obsessively had to think “Litde whore." This symptom stood for the 
incestuous instinctual demand, against which the ego was defending itself. It 
offers an example of an unsuccessful attempt to isolate tenderness from sensuality. 

It was interesting to observe how the patient, who had a certain tendency 
toward paranoid reactions, combined in his defense against instinct the mecha- 
nisms of isolation and projection. Once, in order to demonstrate the absurdity of 
psychoanalysis, he stated that free association was nonsense because people had 
only those ideas they wanted to have. He was told that this was not true, for he 
had the idea “litdc whore” without wanting to have it. A few days later he threw 
up to the analyst the analyst’s sensuality and vulgarity in calling his friend a litdc 
whore and in misusing his confessions to accuse him of low behavior (41 1). 

Sometimes compulsive patients effect a remarkable isolation by means of mar- 
riage. They resolve that their connubial life should have no connection with their 
infantile sexuality. “Now I am married; thus I do not need to worry about sexual- 
ity any more.” Marriages on this basis cannot be happy. The patients erect severe 
compulsions and obsessions at points where infantile sexual strivings might enter 
the marriage despite the isolation. 

It has been mentioned that the most important special case of isolation con- 
sists in the isolation of ideational content from its emotional cathexis. Typical 



288 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 

compulsion neurotics appear to be cold, abstract, and emotionless; actually their 
emotions may be finding expression in some incongruous way. 

An example of how “isolated” such expressions may be is represented by a pa- 
tient who made a note that he should not “forget that he was angry. 

The difficulty compulsion neurotics have in associating freely in analysis is 
due to their isolating propensities. They cannot associate freely because they are 
always on guard to prevent those things that originally belonged together from 
again making contact. They cannot let themselves be surprised either by feelings 
or by perceptions that have not as yet been put into categories. Thinking in com- 
pulsive categories represents a caricature of logical thinking: logical thinking, 
too, is based on a kind of isolation. But the logical isolation serves the purpose 
of objectivity, the compulsive isolation that of defense (6i8). 

Isolation, it has been mentioned, is related to the ancient taboo of touching 
(6i8) (see p. 159). Numerous compulsive symptoms regulate the modes in 
which objects should be or must not be touched. The objects represent genitals 
or dirt. “Clean’* things must not communicate with “dirty” ones (989). An appli- 
cation of the taboo of touching to the magical fear of changing a present situa- 
tion and starting a new one (see p. 284) is presented in the frequent threshold 
rituals (30, 390). 

Isolation frequently separates constituents of a whole from one another, 
where the noncompulsive person would only be aware of the whole and not of 
the constituents. Compulsion neurotics, therefore, frequently experience sums 
instead of unities, and many compulsive character traits are best designated as 
“inhibition in the experiencing of gestalten" 

“Repetition” as a form of “undoing” has been mentioned {see pp. 153 f.). The 
idea is that for the purpose of undoing, an activity has to be repeated with a differ- 
ent intention. What once was done with an instinctual intention must be repeated 
with a superego attitude. The warded-off instinct, however, tends to enter the 
repetition also; thus the repetition has to be repeated. Usually, the number of 
necessary repetitions quickly increases. “Favorite numbers,” the choice of which 
may have their separate unconscious meaning, are set up and determine the 
number of necessary repetitions; eventually, the repetitions may be replaced by 
counting. 

The favorite numbers as a rule are even ones. Only even numbers give the 
guarantee that neither instincts nor superego will overbalance. Most “symmetry** 
compulsions have the same meaning (479) . 

It would be wrong, however, to believe that all compulsive counting is moti- 
vated in this way. Counting may have various other meanings. Frequently it 
represents a counting of seconds, that is^ a measuring of time. The need for meas- 
uring time may have various determinants. Sometimes it is siinply a means of 



OBSESSION A.ND COMPULSION 


289 

making an isolation certain. It may be forbidden to start some activity Immedi- 
ately after another one, and the counting is to ensure the necessary time interval. 
The basic connections between time measuring and anal eroticism have been 
mentioned. The time measuring, being originally a measurement of the interval 
between two occasions of being placed on the toilet, may then be used as a defense 
against the temptation toward anal masturbation, and may eventually become a 
substitute for anal masturbation (737). 

Compulsive counting can also be a defense against wishes to kill, for counting 
things is a reassurance that none of them is missing. But the defense may be in- 
vaded by the impulse, and counting unconsciously comes to stand for killing; 
then it, too, must be warded off (88). This is facilitated by the circumstance that 
counting in itself has the meaning of taking possession, of mastering; “counting” 
may mean “counting one’s possessions.” 

A very simple example of the mechanism of undoing is the frequent washing 
compulsion. Washing becomes necessary as a means of undoing a preceding 
“dirtying” action (real or imaginary) (703, 989). 

This dirtying action is, as a rule, masturbation or, later, the idea of a remote 
possibility of masturbation (503). The anal regression is responsible for the dirt 
conception of sexuality (485). Anal masturbation in childhood was actually be- 
trayed by soiled or odorous hands, and this possibility of betrayal could be avoided 
by washing. Occasionally, patients with a compulsion neurosis can make all their 
scruples disappear by bathing or changing their clothes, “bad feelings” being con- 
ceived of as dirt that can be washed away. Ritual bathing as a means of washing 
away sins is also a manifestation of undoing. It is probably for this reason that 
neurotic ceremonials during the latency period so frequently are related to wash- 
ing. Obstinate children, who refuse to wash, are really refusing to give up their 
pleasurable instinctual impulses. It is true, however, that rituals around undress- 
ing and going to bed are also prevalent for another reason: these occasions pre- 
sent a temptation to masturbate. 

Many typical compulsive symptoms strive at undoing aggressive actions, 
usually imaginary. This intention is sometimes manifest, as in the compulsive 
closing of gas jets or the taking away of stones from the street; sometimes the 
intention is revealed in analysis only, as in the various symptoms with the un- 
conscious meaning of penance. There is no sharp borderline between penance 
symptoms and creative sublimations performed as counteractions against in- 
fantile sadistic strivings (1422, 1424). 

The use of regression, reaction formation, isolation, and undoing makes super- 
fluous the employment of the defense mechanism of repression proper. This an- 
swers the question as to how it is possible, in compulsion neuroses, for offensive 
impulses to come to consciousness. The conscious impulse to kill, for example, is, 
through isolation, so far removed from any possible motor expression that there 
is no chance for the impulse to be materialized, and thus it may safely become 
conscious. Hence when the idea becomes conscious, it is “stripped of emotion** 



290 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


(1054). The result of the disruption of the original connection is that a spon- 
taneous consciousness of the pathogenic childhood events cannot be directly used 
by the analyst. Since the corresponding emotions are lacking, the analyst knows 
as little as the patient which of the childhood memories are important and in 
what their importance consists; even were he aware of it, he could not tell the 
patient before having overcome his resistance against seeing the true connection. 

The lack of repression proper in compulsion neurosis, however, is but a rela- 
tive one. The compulsions and obsessions themselves may undergo a secondary 
repressive process. Sometimes the patients are not able to tell what their com- 
pulsions consist of; the compulsions have a colorless, vague, dreamlike quality, 
and it takes a good deal of analytic work to remove the repressions sufficiently 
for the text of the compulsions to become legible. 

Sometimes compulsive symptoms are secondarily repressed because the patient 
feels that his compulsions do not fit into his system; that is, they represent not 
only defensive forces but also the warded-off instinct intruding again. Trying 
to fit his compulsions into his system, he falsifies and obscures their original con- 
tent. His own compulsions, like the whole world, have to be adapted to the 
system which is his only guarantee of security. 

The displacement in compulsion neurosis often is a “displacement onto a small 
detail.” Many compulsion neurotics have to worry very much about small and 
apparently insignificant things. In analysis, these small things turn out to be 
substitutes for important ones. The best known example is the “thinking com- 
pulsion” (Gruebelzwang) in which the patient is compelled to spend hours 
brooding about very abstract matters. This symptom is based on an attempt to 
avoid objectionable emotions by escaping from the world of emotions into that 
of intellectual concepts and words. This escape fails; intellectual problems, to 
which the patient tries to flee from his emotions, acquire, by the return of the 
repressed, the highest emotional value. 


THE DOUBLE FRONT OF THE EGO IN COMPULSION NEUROSIS 

Not only are the specific defensive mechanisms characteristic of compulsion 
neurosis but so also is the direction in which they are used. The relative pre- 
ponderance of the ego’s dependency on the superego in this neurosis makes it 
comprehensible that the ego is obliged not only to obey the superego in warding 
off instinctual demands but also to try to rebel against it. It may use the same 
defensive measures against the superego that it usually employs against the id 
impulses. This activity, too, needs a continuous expenditure of energy. It has 
been mentioned that the compulsive idea, “If you do this or that, your father 
will die,” is an awareness of the superego’s warning, “If you do this or that, you 
may be tempted to murder your father.” The ego may react to such a threat with 



OBSESSION AND COMPULSION 


291 


a counterthreat. When the rat-man had his first sexual experience, he had the 
obsessive idea, “This is glorious! One might murder one’s father for this!” (567). 
Actually the ego behaves toward the superego as it did previously toward its 
educators: obediently, rebelliously, or obediently and rebelliously simultaneously. 
The ambivalence of the ego toward the superego is the basis of the frequent 
preponderance of religious symptoms in compulsion neurosis (560). 

The ambivalent conflict in regard to the superego can be best observed when it 
produces a biphasic behavior. The patient behaves alternately as though he were 
a naughty child and a strict punitive disciplinarian. 

For obsessive reasons a patient was not able to brush his teeth. After not brush- 
ing his teeth for a while, he would slap and scold himself. Another patient alw^ays 
carried a notebook, in which he would make check marks according to his con- 
duct to indicate praise or blame. 

In dreams, absurdity signifies a mocking and malicious intention of the 
dreamer (552). Similarly, the crass absurdity of many of the pseudo problems 
which are the subjects of obsessive thoughts indicates a malicious and mocking 
attitude on the part of the patients toward their superego, often, during analysis, 
represented by the analyst. Thus the patient’s absurdities are a continuation of 
the child’s ridicule of the father (567). 

A patient, in his first consultation, asked the analyst whether analysis would 
relieve him of his excessive masturbation. The analyst assured him that if the 
analysis were successful at all, it would help in this respect, too. Many months 
later the patient reported that at this moment he had thought: “I wonder how it 
will be possible for analysis to make me stop masturbating if I do not stop it my- 
self”; and he made the resolution not to stop, just to see how the analyst could 
perform the task of making his masturbation stop without effort on his part. 

The regression to anal sadism has not only modified the ego, whose -sadism 
and ambivalence are then directed against the superego as well as against exter- 
nal objects; it also has modified the superego itself, so that it becomes more sadis- 
tic and presents automatic and archaic features, such as working according to 
the talion principle and obeying the rules of word magic. The sadism of the su- 
perego, resulting from the regression, increases the more the ego refrains from 
externally directed aggression. One might suppose that a person strict with him- 
self and outwardly unaggressive may be refraining from aggression because of 
his strictness; actually. the blocking of the aggression is primary and the strict- 
ness of the superego secondary; the sadism, no longer directed against objects, is 
turned inward as the superego’s aggression against the ego (613). 

The morality demanded by the archaic superego of the compulsion neurotic 
is an automatized pseudo morality, characterized by Alexander as the corrupti- 
bility of the superego (37). If the ego makes a concession to an instinctual urge, 
it must comply with demands for atonement; when it has atoned, it may use 



292 


THE PSYCHOANALYTIC THEORY OF NEUROSIS 


the act of atonement as a license to engage in other transgressions; the result is 
an alteration of ‘'instinctual” and “punitive” acts. The need for a relative stabil- 
ity between the two attitudes may be expressed in magical symmetry compul- 
sions. 

Symmetry compulsions have very manifold forms. They all consist of avoiding 
“disturbances of equilibrium.” Whatever happens to the right has to happen to the 
left; whatever is done upward has to be done downward; no counting may stop 
at an odd number, and so on. All this may have special significance in individual 
cases. It always has the general purpose of preventing the mental equilibrium 
from being disturbed by the warded-off impulses; any “instinctual” movement 
is “undone” by the symmetrical countermovement (479). 

Schilder collated forms of compulsions around symmetry that are based on 
conflicts around equilibrium eroticism (1384, 1386) and forms that manifest 
themselves in abstract drawings (1395). 

To understand the “corruptibility” of the superego, one should consider the 
economic relation that has been discussed by Rado as idealization (1237). By 
fulfilling the demands of the superego, the ego gains a narcissistic pleasure 
which may bring with it such an exhilaration that it temporarily suspends or 
weakens its function of objectively judging reality and impulses. 

The ideas that any suffering entitles one to the privilege of a compensating 
pleasure and that a threatening superego may be placated and forced to renew 
its withdrawn protective powers by means of voluntary suffering are very archaic 
ones. The same ideas are expressed in the attitudes of sacrifice and prayer. In both 
practices, the sympathy of God is bought, and more intense punishments arc 
avoided by means of the active and voluntary acceptance of an unpleasantness as 
“prophylactic punishment.” The extremes of this attitude are those actions that 
can be called prophylactic autocastrations. Buying God’s sympathy may turn into 
blackmail. In impulsive and depressive neurotics we find many variations of such 
blackmail. Ultimately the circle, deed — punishment — new deed, can be traced 
back to the circle, hunger — satiation — ^new hunger {see p. 411). 

The vacillation between deed and punishment is frequently expressed in ob- 
sessive doubts, which really mean: “Shall I follow the demands of the id, or 
those of the superego?” Severe compulsion neuroses may terminate in states in 
which the conscious ego, having become a football for the contradictory impulses 
of the id and the superego, is eliminated completely as an effective agent (109, 
1292). 

In defending itself against the demands of the sadistic superego, the ego may 
use a countersadistic rebellion as well as submission (ingratiation), or both atti- 
tudes simultaneously or successively. Sometimes the ego seems willing to take 
upon itself punishments, acts of expiation, and even torture to an astonishing de- 
gree, This “moral masochism” appears to be a complement to the “sadism of the 
superego, and this submission may be performed in the hope of using it as a 



OBSESSION AND COMPULSION 


293 


license for later instinctual freedom. The ego’s “need for punishment” is, in 
general, subordinated to a “need for forgiveness,” punishment being accepted 
as a necessary means for getting rid of the pressure of the superego. Such a need 
for punishment on the part of a compulsive ego, however, may become condensed 
with masochistic sexual wishes. Then, in the words of Freud, morality, which 
arose from the Oedipus complex, has regressed and has become Oedipus com- 
plex once again (613) {see p. 364). 

In general, a need for punishment is but a symptom of a more general need 
for absolution; this is clearly seen in the attempt to avoid punishment by attain- 
ing absolution without it, through using external objects as “witnesses” in the 
fight against the superego (1288, 1289, ^599)* 

A patient invented a method for dispensing with scruples and hypochondriacal 
fears. After having masturbated, he would go to a physician who would make a 
physical examination and assure him that he was in good condition. Analysis 
showed that the assurance of the physician represented the renunciation by a 
“castrator” of his right to castrate; the declaration of health represented the 
needed absolution. This absolution ended the patient's bad conscience and made 
any other means of doing so unnecessary; in particular, the patient no longer 
needed to punish himself. 

A reliance on the assurances of others to maintain his self-esteem often deter- 
mines a compulsive patient’s social behavior. The patient feels relieved when he 
finds that other persons do not regard his guilt as gravely as he docs himself. It 
is as if he told his superego: “It cannot be so bad after all, since so-and-so does not 
condemn me.” By this process, the fear of the superego is changed back into a 
social fear. This reprojection of the superego is found to a greater extent among 
persons with paranoid trends; but the analysis of simple compulsion neurotics, 
too, frequently shows that their social anxiety is a fear that their attempt to ease 
a severe sense of guilt may fail. The feeling that they are nevertheless guilty 
may be turned into a chronic social fear. And naturally a person who uncon- 
sciously is very aggressive toward the external world has every reason to fear 
that the world will not like him {see p. 519). 

Although the conflicts of the compulsion neurotic are more internalized than 
arc those of a hysteric, compulsion neurotics try to use external objects for the 
solution or relief of their inner conflicts. Hysterics who are afraid of being cas- 
trated or of not being loved any longer may try to influence the people around 
them directly, in order to dissuade theip from doing the things they fear. The 
compulsion neurotic, more fearful of losing the protection of his own superego, 
of being compelled to despise himself, needs other people as an indirect means 
of gaining relief. Whatever the objects do or say is looked upon as either for- 
giveness or accusation. Various attempts, real and magical, arc made to influence 
the testimony of these “witnesses.” Sometimes the patient tries to induce objects 



294 THE PSYCHOANALYTIC THEORY OF NEUROSIS 

simply to give signs of sympathy. Sometimes the objects arc expected to do what 
the patients themselves do not dare to do. Sometimes they are expected not to do 
what the patients themselves do not dare to do because this would create a too 
intense temptation. 

According to Freud the unconscious basis of the concept of justice is the idea: 
“What I am not permitted to do, no one else should be permitted, either” (606). 
The urge for justice is rooted in the tendency to maintain a prohibition by in- 
sisting that everyone else be subject to it, too (40). There is a relationship be- 
tween “justice” and “symmetry.” Some longings for justice mean simply: “It is 
fair that what happened to the right must happen to the left.” And sometimes 
the longing for symmetry means: “Symmetry is achieved if what happened to 
one child happens to the other brothers and sisters as well.” 

Freud stated that persons who have put the same object in the place of their 
superego identify themselves with one another (606). Following Rcdl (1258) 
we may add: so, too, are persons who use the same “witness” united by mutual 
identification. 

In extreme cases, eventually the patient s behavior may become entirely un- 
genuine. Whatever he does, he does for the purpose of impressing a fantasied 
audience or rather a jury. 

An ambivalent dependence on a sadistic superego and the necessity to get rid 
of an unbearable guilt tension at any cost are the most frequent causes of sui- 
cide, Thus the question arises: If it is true that these factors play so prominent 
a role in compulsion neurosis, why is suicide so rare among compulsive patients? 
Freud gave the following answer. In compulsion neurosis, in contrast to depres- 
sion, the libido of the individual is not totally involved in the conflict between 
the ego and the superego; a large part of the patient’s object relationships is pre- 
served, and this circumstance protects him from ruin; it may even be that the 
regressive distortion of these remaining object relationships, that is, their sadistic 
nature, contributes to this favorable effect: because the compulsion neurotic suc- 
ceeds in actually expressing so much aggression against objects, he does not need 
to turn so much aggression against himself (608). 

Guilt feelings nevertheless cause compulsion neurotics to suffer a great deal. 
The patients enter an ever growing cycle: remorse, penitence, new transgres- 
sions, new remorse. The compulsion neurotic tends to develop more and more 
displacements, to extend the range of his symptoms (analogous to the “phobic 
facade”) and to increase the instinctual significance of the symptoms at the ex- 
pense of their punitive significance. 

The prevalent need to vise objects for finding relief in inner conflicts, over- 
shadowing all direct feelings toward objects, is not the only factor that generally 
distorts the object relationships of compulsion neurotics, A second one is the sim- 
ple fact that the anal-sadistic regression prohibits the development of mature ob- 
ject relationships. It produces an unreliable, ambivalent attitude toward objects, 



OBSESSION AND COMPULSION 


295 


conflicts of bisexuality and retention of the aims of incorporation. A third cir- 
cumstance that disturbs object relationships is the isolation of emotions so that 
the object relationships lack genuineness and warmth. The cathexcs, which are 
attached to symptoms and autoerotic substitutes, are absent when the patients 
have to deal with objects {see pp. 242, 508, and 515). 

THINKING IN COMPULSION NEUROSIS 

The regression toward anal sadism and the continuous conflict with the super- 
ego influence the thinking processes of the compulsion neurotic in a characteristic 
way: they become permeated or replaced by their archaic forerunners. 

In contrast to the visual daydreams of the hysteric, the fantasies of the com- 
pulsion neurotic are verbalized and bring back the archaic attitudes that accom- 
panied the first use of words. 

The ego’s function of judgment by anticipation is immensely facilitated by 
the acquisition of words. The creation of this replica of the real world makes* it 
possible to calculate and act out in advance in this “model world” before real 
action is taken {see pp. 46 ff.) . Words and worded concepts are shadows of things, 
constructed for the purpose of bringing order through trial acting into the chaos 
of real things. The macrocosm of real things outside is reflected in the micro- 
cosm of thing representatives inside. The thing representatives have the charac- 
teristics of the things, but lack the character of “seriousness” which the things 
have; and they are “possessions”; that is, they are mastered by the ego; they are 
an attempt to endow the things with “ego quality” for the purpose of achieving 
mastery over them. He who knows a word for a thing, masters the thing. This 
is the core of the “magic of names,” which plays such an important part in magic 
in general (916). It is represented in the old fairy tale of Rumpelstilzchen, in 
which the demon loses his power once his name is known. ^ 

A patient knew several hundred names of birds; as a child he had been afraid 
of the stork, as the demon of birth and death. A child knew all railway stations by 
heart; his analysis showed that he had had a phobia concerning railways several 
years before. Another child had an extraordinary memory for persons’ names; it 
was a way in which he mastered an original social anxiety. 

The compulsion neurotic, being afraid of his emotions, is afraid of the things 
that arouse emotions. He flees from the macrocosm of things to the microcosm 
of words. Being afraid of the world, he tries to repeat the process by which, as 
an infant, he learned to master the frightening aspects of the world. This time, 
however, under the pressure of warded-off impulses, the attempt fails. When he 
tries to flee from the emotion-arousing things to the sober words, what has been 
warded off comes back and the sober words do not remain “sober” but become 
emotionally overcathected; they acquire that emotional value which things have 
for other persons. 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


296 

The first words acquired in infancy are magical and “omnipotent” because 
the microcosm is not yet differentiated enough from the macrocosm but still has 
its emotional value (457) . Blessing and cursing are expressions of the still effec- 
tive macrocosmic quality of words* In the further development of the faculties 
of thought and speech, the gay world is made drab in order to facilitate its man- 
agement. Only certain irrational thoughts and words remain gay, like daydreams 
or obscene words (451). In compulsion neurosis, thinking and talking have be- 
come substitutes for the emotions connected with reality; they regain their origi- 
nal qualities, become “sexualized” and lose their value for practical use. Words 
once more become powerful blessings or curses (1154). 

Words again can kill and resurrect. They can perform miracles and turn time 
back. By a mere verbal statement, the compulsion neurotic, unconsciously, be- 
lieves that he can coerce reality into pursuing the course he desires. Because 
words and thoughts are believed to have such real effects, they are also danger- 
ous. A careless word might make effective the sadistic impulses that have been 
warded off with so much care. Words and thoughts have to be handled cau- 
tiously and, if necessary, warded off and undone. Their misuse calls for the same 
punishment as a misdeed. They become the regressive substitutes for deeds 

(567). 

Because the omnipotence of words (457) is especially preserved in obscene 
words, which have kept their magical power, causing the speaker and hearer to 
experience the things mentioned as if actually perceived (451), they are often 
the subject of compulsive symptoms. An embarrassed reticence that prevents the 
utterance of obscene words (often disturbed by a sacrilegious compulsion to utter 
just these words in the most embarrassing connections) is a defense against a spe- 
cific impulse to say them. This impulse, which may appear as a perversion {see 
pp. 350 f.), is more frequently felt as a compulsion. It has the goal of magically 
compelling the hearer to have a sexual experience. This, however, is usually not a 
simple sexual wish. It serves, rather, the purpose of combating some anxiety that 
is unconsciously connected with sexual ideas. The sadistic factor in this urge is 
obvious, as is the fact that anal words bring anal pleasure and sexual speaking 
itself is an oral-libidinous gain. Coprolalia is a matter of “regressed libido” and 
therefore plays a great part in the symptomatology of compulsion neurosis. 

The fear of the omnipotence of his thoughts (457, 567) makes the compul- 
sion neurotic dependent on his thinking. Instead of mastering the world by 
means of thinking, his (compulsive) thinking, replacing his uncontrolled sex- 
uality, masters him. 

The tendency to use “omnipotent” words as a defense against danger explains 
the fact that secondary defensive measures against compulsive symptoms often 
have the compulsive form of worded magical formulae. The relation of com- 
pulsive formulae to the magical formulae of primitives has often been discussed 

(579)- 



OBSESSION AND COMPULSION 


297 


A patient who worried obsessively that the analyst might die during one of his 
sessions was, in consequence, compelled to turn and look at the analyst, and to 
reassure himself by uttering the formula: “The living doctor is sitting behind me 
at a distance.” “At a distance” reassured him that he did not violate a taboo of 
touching. 

Freud showed that the belief in the omnipotence of thought corresponds to 
a real fact. Thoughts, to be sure, have no such external efficacy as the compulsion 
neurotic imagines; but within himself, thoughts are really much more powerful 
than in normal persons. Compulsive thoughts are really compelling, and this 
quality is their power (567) . This power is partly a derivative of the biological 
force of instincts and partly a derivative of the power of the father’s demands. 
Compulsion neurotics, although dependent on their compulsions, actually are 
not aware of this connection. They really underestimate the internal power of 
thought as much as they overestimate their external force. 

The retreat from feeling to thinking succeeds, as a rule, in one respect : com- 
pulsive thinking is abstract thinking, isolated from the real world of concrete 
things. 

Compulsive thinking is not only abstract, it is also general, directed toward 
systematization and categorization; it is theoretical instead of real. The patients 
are interested in maps and illustrations rather than in countries and things. 

But in another respect the retreat, as a rule, fails. The cleavages and contra- 
dictions that permeate the emotional life of compulsion neurotics are displaced 
to the sexualized intellectual problems, resulting in obsessive brooding and 
doubt. Doubt is the instinctual conflict displaced to the intellectual field. 

A patient, looking at a door, was compelled to spend much time brooding about 
the problem: What is the main thing, the empty space, filled out by the door, or 
the substantial door, filling out the empty space.? This “philosophical” problem 
covered the other doubt: What is the main thing in sexuality, woman or man? 
And this again meant: What is the main thing in me, femininity or masculinity? 

The unconscious content of obsessive doubts may be manifold; yet the mani- 
fold conflicts are but special editions of a few general questions. They are con- 
flicts of masculinity versus femininity (bisexuality), of love versus hate (ambiva- 
lence), and especially of id (instinctual demands) versus superego (demands of 
conscience). 

The last formula is the decisive one. Bisexuality and ambivalence do not form 
conflicts in themselves; they do so only if they represent a structural conflict be- 
tween an instinctual demand and an opposing force as well. 

Certain obsessive doubts are of a somewhat simpler nature. Some doubts as to 
the validity of one’s own perceptions or judgments represent the wish that what 
is doubted should not be true. The doubted facts may stand for primal scenes or 



THE PSYCHOANALYTIC THEORY OF NEUROSIS 


298 

for the anatomical sex difference. The relatively frequent symptom of obsessively 
doubting the news of a death is, first of all, a fear of the omnipotence of one’s 
own thoughts: the patient tries to deny the news because he wants to ward off the 
idea that it might be his own fault. If the doubt becomes so torturing that the 
patient says “Thank heavens!” in relief at the very confirmation of the news, 
the psychological connection is the following. If the doubt were justified and the 
idea of the death had originated in a misapprehension, the fact that the patient 
had been thinking such bad thoughts would become obvious. Therefore the con- 
firmation of the news is felt as a relief which nullifies the suspicion that one might 
have thought maliciously about a person’s death. 

An insight into the nature of obsessive brooding and doubting furnishes a sim- 
ple technical rule: never to discuss with compulsion neurotics their obsessive 
problems. By doing so the analyst would confirm the patient’s isolation mecha- 
nisms. As long as the patient’s thoughts are isolated from his emotions, only this 
isolation should be the subject of analysis and not the content of what has been 
isolated. 

Connected with the shift of emphasis from acting to thinking is the following 
idea. Thinking is preparation for action. Persons who are afraid of actions in- 
crease the preparations. In the same way as compulsion neurotics think rather 
than act, they also prepare constantly for the future and never experience the 
present. Many compulsive symptoms have the nature of preparations for a 
future that never becomes present. The patients behave like Tyll Eulenspiegel, 
rejoicing in the walk uphill because he thought of the future downhill trip, sad 
when going downhill because a later uphill trip was coming. 

The main cause for exaggerated preparation is certainly the fear of the “real 
thing.” Simultaneously, the tendency to prepare expresses an anal forepleasure, 
the infantile postponement of defecation, which in itself also had a double na- 
ture: striving for the avoidance of a sudden loss of control and for the achieve- 
ment of an erogenous pleasure. The “trifling” parts toward which the compul- 
sion neurotic displaces the emphasis from the important whole represent the 
“preparations” instead of the “real thing.” 

The compulsion neurotic, busy with preparations, acts according to the rule: 
the status quo is better than anything a change might bring. The status quo is 
a lesser evil. 

The fear of any change from the known present condition to a possibly dan- 
gerous new state makes patients cling even to their symptoms. The neurosis, un- 
comfortable as it is, is well known and a “lesser evil,” as compared with the possi- 
bilities any change might bring. Such an attitude often forms a latent resistance 
which limits the otherwise good progress of an analysis. To the patient, then, the 
neurosis is an old acquaintance. Some forms of “negative therapeutic reaction” to 
the analytic cure (608) express such fear of any change (818, 1315). 

The fear of change may be replaced or accompanied by its opposite, a tendency 
to change continuously. Actually the world does not obey any patient’s compul- 



OBSESSION AND COMPULSION 


299 


sive system. Hence some compulsion neurotics have the tendency to change ev- 
erything everywhere, trying to bring the world into accord with their system. 

Good examples of the belief in the omnipotence of thought, of guilt feelings 
due to this belief and an attempted defense against the guilt feelings by orderli- 
ness are shown by the following case: 

In the days before the outbreak of the war, a patient was hanging up his coat 
in the closet. He suddenly felt the compulsive command: “You have to hang the 
coat especially neatly.” He answered with a resistance: “I am too lazy.” He felt 
the compulsive threat: “If you do not hang the coat neatly, war will break out.” 
He did not care. 

A few days later war broke out. The patient remembered immediately the 
episode with the coat. He knew, of course, that it was not his carelessness that had 
caused the war, but he felt as if this were the case. He had, earlier, been con- 
vinced that he would die in a war; now he felt it a just punishment for his care- 
lessness in hanging the coat. 

The patient’s interest in war had a long history. As a child he was very much 
afraid of his tyrannical father, and warded off his anxiety by frightening his 
little brother. He behaved rather sadistically toward this litde brother, especially 
when playing war. When the patient was adolescent, the brother died of an ill- 
ness. The patient reacted with the obsessive idea that he, the patient, would die 
in a war. This obsessive thought expressed the unconscious idea: “I killed my 
brother while playing war; therefore I have to expect the talion punishment of 
death in war.” 

The patient’s father stressed orderliness very much. Hanging up the coat cor- 
rectly meant obedience to his father. Arguments like “You have to hang up the 
coat,” “I am too lazy” had taken place frequently between the father and the pa- 
tient. Later on, orderliness, meaning obedience to the father, acquired the un- 
conscious meaning of an assurance that he would not kill the father. “Careless- 
ness” meant “taking the risk of killing and of being killed.” On the day when the 
incident with the coat occurred, the patient had experienced a professional frus- 
tration and was especially angry. 

The connection of the “microcosm” of words with the idea of “mastering pos- 
sessions” makes it comprehensible that wherever a sexualization of thinking 
occurs, the sexuality attached to the thinking has an anal quality. During analy- 
sis, compulsion neurotics frequently equate, consciously or unconsciously, the 
production or nonproduction of associations with the production or nonproduc- 
tion of feces. 

A woman patient, who often had to speak in public, showed the obvious equa- 
tion of her words not with feces but with urine. When speaking, she often used 
to “lose control” of her words, which gushed from her mouth. Sometimes they 
suddenly stopped, and she experienced a kind of stage fright, not knowing what 
to say and feeling that she had run out of material. But she invented a simple 
trick for overcoming this uihibition: she had to have a bottle of water on her desk, 
and after having “filled herself up” with water, she would let the words run out 
again. 



300 the psychoanalytic theory of neurosis 

Analysis can also demonstrate that details in the manner of speaking or think- 
ing of a much more delicate nature frequently are repetitions of corresponding 
details in infantile toilet habits. The fantasies of omnipotence that are connected 
with thoughts and words turn out to be repetitions of the infantile narcissistic 
overestimation of the excretory functions (19). 

In accordance with the anal sexualization of thoughts and words is the fact 
that neurotic manifestations in head and vocal organs are often found in analysis 
to be dependent on anal eroticism. 

This finding is not inconsistent with the fact that thought and speech are often 
used as symbols for the penis, and the ability to think or speak is thought of as a 
sign of potency (215, 520). The concurrence of anal and phallic significance in 
obsessions and compulsions is due to the regression. 

It may be that the physiological relation between the blood volume of the head 
and that of the abdominal organs helps to establish this unconscious connection 
of “thoughts” and “feces.” 

An obsessive patient, who suffered from chronic headaches, referred to this 
symptom by saying: “My nerves are hurting me.*’ “Nerves” he imagined as white 
or pinkish threadlike structures, an idea he had acquired at the dentist’s, where 
he saw a “nerve” of a tooth. Once he dreamed of his “vagus nerve,” that is, of the 
nerve that “wanders.” He referred to a white thread that might have pushed its 
way into his head from below and now might walk around within his head and 
in this way cause his headache. This idea was connected with a definite childhood 
experience: he had had threadworms. Unconsciously he supposed these worms 
now to produce as many head symptoms as they had produced anal symptoms 
when he was a child. 


MAGIC AND SUPERSTITION IN COMPULSION NEUROSIS 

The overvaluation of intellect often makes compulsion neurotics develop 
their intellect very highly. However, this high intelligence shows archaic fea- 
tures and is full of magic and superstition. Their ego shows a cleavage, one part 
being logical, another magical. The defensive mechanism of isolation makes 
the maintenance of such a cleavage possible. 

The superstition of the compulsion neurotic was the subject on which Freud 
first demonstrated “similarities in the mental life of savages and neurotics” 
(579). It is based on an augmented narcissism, connected with the regressive 
re-establishment of the more or less original infantile omnipotence (457). Ob- 
sessive games around this omnipotence arc aimed at contradicting feelings of de- 
pendence and unconsciously are equivalents of “killing the father.” 

A patient derived much pleasure from playing with a litde paper bouquet 
which changed its form when shaken, somewhat like a kaleidoscope. Analysis 
showed that he was “playing God,” magically creating new worlds. Another pa- 



OBSESSION AND COMPULSION 


301 


tient, performing ceremonials with his bedcover, used to fantasy as a child that 
he was God creating the world. Analysis showed that “creating the world” meant 
“creating children,” and that unconsciously he played the part of his father, hav- 
ing intercourse with his mother. This world-creating intercourse, however, was 
perceived as an anal act, and the pretended omnipotence was an outcome of the 
infantile narcissistic overestimation of the excretory functions (19). Another pa- 
tient, whose analysis had sharpened his faculty for self-observation, found himself 
thinking how queer it was that he had to open a door in order to pass through it. 
He actually expected that his wish would be sufficient to make the door open by 
itself. The rejection of this idea by the upper levels of the ego differentiates such 
a belief from a delusion of grandeur. 

The complement of creating worlds by magic is the “wishing away” of an un- 
desired piece of the world, the strange ability to deny reality at the point where 
it opposes the patient’s wishes. A true loss of capacity for testing reality is a char- 
acteristic feature of psychoses (611). In neuroses, the typical “turning away from 
reality” is “introversion,” a turning away from real objects toward the images 
of infantile objects. In this respect, the compulsion neurotic, because of his “om- 
nipotence,” stands a step nearer to psychosis than does the hysteric. An uncon- 
scious part of the ego may repudiate parts of reality, while the conscious person- 
ality at the same time really knows what is true and what is false. 

Because of his obsession for neatness, a patient with geographical obsessions 
was troubled by the artificial boundaries between countries. It was his wish that 
there should only be countries that are geographical units. Therefore, he referred 
to the entire Iberian peninsula as “Spain,” ignoring the existence of Portugal. 
One day he was introduced to a foreigner. The patient asked him what his na- 
tionality was.